Justification of update of the Lyon Consensus
| Key areas in need for update identified by the steering committee | Entities not covered in original Lyon Consensus | Entities covered in update of Lyon Consensus |
| Modern definition of actionable GERD in the context of presenting symptoms | Concept of ‘actionable GERD’ | Description of conclusive GERD where oesophageal testing supports revising, escalating or personalising GERD management |
| Modern definition of GERD | Definition of GERD that takes both troublesome symptoms and oesophageal test results into consideration; criteria that rule out GERD are also defined, for use in diagnostic criteria for disorders of gut–brain interaction | |
| Differential approach to oesophageal evaluation based on presenting symptoms and prior GERD evidence | Description of oesophageal symptoms that have high, intermediate and low likelihood of association with reflux episodes; concept of proven versus unproven GERD in determining testing strategy | |
| Objective endoscopic findings of GERD | LA grade B was considered inconclusive evidence for GERD | LA grade B oesophagitis is considered conclusive evidence of GERD, based on recent studies using prolonged pH monitoring and pH-impedance monitoring that corroborate earlier data from pH-monitoring |
| Discussion of endoscopic findings off versus on antisecretory therapy | Need for performing endoscopy off antisecretory therapy in unproven GERD; endoscopic findings that confirm GERD when tested on optimised therapy | |
| The specific value (or lack thereof) of supportive endoscopic findings | Hiatus hernia on endoscopy is considered supportive evidence for GERD; routine standard biopsy evaluation is not recommended or helpful; endoscopy-based mucosal impedance evaluation needs further research | |
| Wireless pH monitoring indications and metrics | Wireless pH monitoring was not discussed | Indications, thresholds, value and utilisation of wireless pH monitoring is discussed in detail |
| pH-impedance monitoring indications and metrics off antisecretory therapy | Specific indications for pH-impedance monitoring were not discussed | Presentations where pH-impedance monitoring has advantage over pH-only or wireless pH monitoring are specifically discussed |
| Thresholds for mean nocturnal baseline impedance were not elaborated | Thresholds for mean nocturnal baseline impedance are provided and discussed; postreflux swallow induced peristaltic wave index is retired as adjunctive evidence | |
| pH impedance monitoring indications and metrics on anti-secretory therapy in diagnosis of refractory GERD | pH-impedance monitoring was not discussed in the context of on-therapy testing | Indications, metrics and thresholds are provided for use of pH-impedance monitoring on therapy in proven GERD |
GERD, gastro-oesophageal reflux disease; LA, Los Angeles .