Statements and levels of agreement among the core and working groups
| Statements | Median score | % agreement |
| The modern definition of actionable GERD requires evidence of conclusive reflux-related pathology on endoscopy, and/or abnormal reflux monitoring (using Lyon Consensus thresholds) in the presence of compatible troublesome symptoms. | 8.5 | 94 |
| Troublesome typical symptoms alone may be enough for antisecretory medication trials, but up-front oesophageal testing is suggested for all other symptom categories and in PPI non-responders, prior to invasive GERD management or prior to long-term medical management. | 9 | 89 |
| Typical symptoms of GERD consist of heartburn, oesophageal chest pain and regurgitation. | 9 | 100 |
| The relationship of belching to reflux disease is variable, but belching can be part of reflux pathophysiology. | 8.5 | 89 |
| Chronic cough and wheezing have a low but potential pathophysiological relationship to reflux disease. | 8 | 83 |
| Hoarseness, globus, nausea, abdominal pain and other dyspeptic symptoms in the absence of typical symptoms have a low likelihood of pathophysiological relationship to reflux disease. | 8 | 95 |
| LA grades B, C and D oesophagitis, biopsy proven Barrett’s oesophagus and peptic stricture are conclusive for a diagnosis of GERD. | 9 | 94 |
| To maximise the diagnostic yield, endoscopy should be performed 2–4 weeks after discontinuation of PPI therapy in unproven GERD. | 8 | 83 |
| LA grades B, C and D oesophagitis and recurrent peptic stricture while on optimised PPI therapy are indicative of refractory GERD. | 9 | 89 |
| Prolonged wireless pH monitoring off antisecretory therapy is the preferred diagnostic tool in unproven GERD when available, and may provide highest diagnostic yield with study duration of 96 hours. | 8 | 90 |
| Ambulatory pH-impedance monitoring off antisecretory therapy has diagnostic value in unproven GERD when typical reflux symptoms are associated with excessive belching, when rumination is suspected, and when pulmonary symptoms are being evaluated for association with GERD. | 8 | 85 |
| Ambulatory pH-impedance monitoring on PPI is of value in proven GERD with persisting symptoms despite optimal therapy. | 9 | 94 |
| AET<4.0% on all days of wireless pH monitoring with negative reflux-symptom association excludes GERD. | 8.5 | 100 |
| AET>6.0% for ≥2 days is diagnostic of GERD and supports treatment for GERD. | 9 | 89 |
| AET<4.0% on all days with positive reflux-symptom association meets criteria for reflux hypersensitivity. | 8 | 94 |
| Any prolonged wireless pH monitoring study that does not meet criteria for GERD, reflux hypersensitivity or a normal study is considered inconclusive for GERD. | 8 | 83 |
| Total AET >6% off PPI on ambulatory pH monitoring is diagnostic of GERD and supports treatment for GERD. | 9 | 94 |
| Total reflux episodes <40/day is adjunctive evidence for absence of pathological GERD. | 8 | 94 |
| Total reflux episodes 40–80/day off PPI is inconclusive evidence for GERD as a stand alone metric. | 8 | 100 |
| Total reflux episodes >80/day is adjunctive evidence for objective GERD. | 8 | 100 |
| There are not sufficient data regarding thresholds for upright versus supine reflux episode numbers, and acidic versus non-acidic reflux events to incorporate these findings into clinical practice. | 8 | 94 |
| Combination of AET>4% and >80 reflux episodes on an optimised antisecretory regimen is evidence for actionable refractory GERD. | 8 | 95 |
| Baseline impedance of <1500 ohms is adjunctive evidence for GERD, while baseline impedance >2500 ohms is evidence against pathological GERD. | 8 | 90 |
AET, acid exposure time; GERD, gastro-oesophageal reflux disease; LA, Los Angeles; PPI, proton pump inhibitor.