Clinical history, questionnaire data and response to antisecretory therapy are insufficient to make a conclusive diagnosis of GERD in isolation, but are of value in determining need for further investigation. Reflux-symptom association on ambulatory reflux monitoring provides supportive evidence for reflux triggered symptoms, and may predict a better treatment outcome when present.
When endoscopy and pH or pH-impedance monitoring are inconclusive, adjunctive evidence from biopsy findings histopathology scores, dilated intercellular spaces , motor evaluation hypotensive lower oesophageal sphincter, hiatus hernia and oesophageal body hypomotility on high-resolution manometry and novel impedance metrics baseline impedance, postreflux swallow-induced peristaltic wave index can add confidence for a GERD diagnosis; however, diagnosis cannot be based on these findings alone.
An assessment of anatomy, motor function, reflux burden and symptomatic phenotype will therefore help direct management. Future GERD management strategies should focus on defining individual patient phenotypes based on the level of refluxate exposure, mechanism of reflux, efficacy of clearance, underlying anatomy of the oesophagogastric junction and psychometrics defining symptomatic presentations. All rights reserved.
No commercial use is permitted unless otherwise expressly granted. PJK: consulting: Ironwood.
Modern diagnosis of GERD: the Lyon Consensus.
AJPMS: none. MV: Vanderbilt University and Diversatek co-own patent on mucosal impedance technology. MV: consulting: Torax.
How To Convert a Word documents to PDF
RT: teaching: Laborie. JT: consulting: Ironwood.
National Center for Biotechnology Information , U. Didn't get the message? Find out why Add to Clipboard.
Add to Collections. Order articles. Fetching bibliography My Bibliography Add to Bibliography. Generate a file for use with external citation management software.
Create File. Epub Feb 3.
Claraspital, Kleinriehenstrasse 30, Basel, Switzerland. Abstract Clinical history, questionnaire data and response to antisecretory therapy are insufficient to make a conclusive diagnosis of GERD in isolation, but are of value in determining need for further investigation.
Images from this publication.
See all images 3 Free text. Figure 1. Oesophagogastric junction morphology as depicted in HRM. With type 1 morphology the crural diaphragm CD component, evident during inspiration I , is completely superimposed of the lower oesophageal sphincter LES component such that the magnitude of the actual LES pressure is not discernible.
Consenso de lyon 1994 pdf converter
Figure 2. High-resolution manometry metrics used in the motor classification of GERD.
The measurement is made over three respiratory cycles during quiet rest, and corrected for duration of respiration. The distal contractile integral DCI measures vigour of smooth muscle contraction taking length, duration and amplitude of contraction into consideration.
Figure 3. Interpretation of oesophageal test results in the context of GERD. Any one conclusive finding provides strong evidence for the presence of GERD. When evidence is inconclusive or borderline, adjunctive or supportive findings can add confidence to the presence or absence of GERD.
Consenso De Lyon
Histopathology as an adjunctive measure requires a dedicated scoring system incorporating papillary elongation, basal cell hyperplasia, DIS, intraepithelial inflammatory cells, necrosis and erosions or evidence of DIS on electron microscopy.
However, adjunctive findings, particularly histopathology and motor findings in isolation, are not enough to diagnose GERD.