EoE ToT Module 4 References-Gyawali et al Gut 2024 Updates to the modern diagnosis of GERD Lyon consensus 2.0

Gyawali et al Gut 2024 Updates to the modern diagnosis of GERD Lyon consensus 2.0

Pdf Summary

The updated Lyon Consensus 2.0 provides an enhanced framework for diagnosing gastroesophageal reflux disease (GERD) based on evidence from esophageal testing and new research. It outlines conclusive criteria for diagnosing GERD, identifies reliable metrics, and delineates appropriate testing strategies based on whether GERD is unproven or previously diagnosed.<br /><br />Key updates include:<br />1. **Actionable GERD Definition**: Clear criteria outline when clinical management should include long-term acid suppression, escalation of medical therapy, or consideration for interventional procedures. Symptoms are categorized based on their likelihood to be related to reflux.<br /><br />2. **Testing Strategies**:<br />   - **Unproven GERD**: Suggests wireless pH monitoring or catheter-based pH monitoring off antisecretory medication for patients with no conclusive prior evidence of GERD.<br />   - **Proven GERD**: pH-impedance monitoring while on optimized antisecretory therapy for evaluating persistent symptoms in patients with previously confirmed GERD.<br /><br />3. **Significant Change in Endoscopic Criteria**:<br />   - Los Angeles (LA) grade B esophagitis is now considered conclusive evidence for GERD, unlike previous guidelines that were more restrictive.<br />   - Routine biopsies aren't recommended unless there’s suspicion of other conditions like eosinophilic esophagitis.<br /><br />4. **Advanced Diagnostic Metrics**:<br />   - Prolonged wireless pH monitoring thresholds and the addition of metrics like mean nocturnal baseline impedance (MNBI).<br />   - Detailed utility of pH-impedance monitoring both off and on antisecretory therapy, emphasizing identifying atypical symptoms and non-acidic reflux episodes.<br /><br />5. **Differentiating Atypical Symptoms**:<br />   - Provides guidelines for evaluating symptoms like chronic cough, wheezing, and belching, which could inform the choice of diagnostic tests, including linear impedance metrics and behavioral analyses.<br /><br />6. **Diagnostic Methodologies**:<br />   - Adoption of modern stratified approaches, considering patients' unique symptom profiles to avoid inappropriate usage of diagnostics and therapies for non-GERD conditions.<br /><br />The updated consensus emphasizes personalized treatment plans and a thorough application of recent diagnostic advancements, prioritizing specificity in diagnosing GERD to optimize patient outcomes.

Keywords

Lyon Consensus 2.0

GERD diagnosis

esophageal testing

acid suppression

pH monitoring

esophagitis

endoscopic criteria

diagnostic metrics

atypical symptoms

personalized treatment