An international gastroenterology team has issued an updated set of conclusive diagnostic criteria for gastroesophageal reflux disease (GERD), a risk factor for esophageal cancer. The result, Lyon Consensus 2.0, was published in 2024 by the British Medical Journal Gut and provides clearer definitions for the disease, as well as updated diagnostic and treatment criteria.
“By better defining GERD, we can identify people in need of acid-suppression medication to decrease their risk of Barrett’s esophagus and esophageal cancer,” said Rishi Naik, M.D., an assistant professor of medicine in the Division of Gastroenterology, Hepatology and Nutrition at Vanderbilt.
“We have excellent therapies.”
Michael Vaezi, M.D., director of the Center for Swallowing and Esophageal Disorders at Vanderbilt University Medical Center, served on the international study team. He and Naik work closely together in the field.
“Experts from many countries were responsible for this impactful consensus, which I believe will result in improved patient diagnosis and treatment,” Vaezi said.
Symptoms of gastroparesis, functional heartburn, or reflux hypersensitivity may be misdiagnosed as GERD in some cases. The new “modern definition” of GERD describes symptoms having a higher or lower likelihood of an objective GERD diagnosis.
“Esophageal testing supports revising, escalating, and personalizing GERD therapy,” Naik said.
“For clinicians who manage patients who present with symptoms of GERD, this new Lyon Consensus offers clear management pathways that grew out of the most recent evidence.”
Avoiding Unneeded Tests
“When we meet the patient in the clinic we ask: what is their chance of having acid reflux? We are trying to enrich the pretest and not put people through unnecessary testing,” Naik said.
Lyon 2.0 provides updates to the timing of abnormal acid exposure, which determine the need for therapy in actionable GERD. Also, the new document provides clarity about different testing strategies that can be used in treating proven versus unproven GERD.
For clinicians who are managing patients with symptoms of GERD, this new Lyon Consensus offers clear management pathways based on the most recent evidence.
“One of the biggest changes for Lyon 2.0 when it comes to ambulatory reflux testing is that if the patient’s acid exposure was over 6.0 percent for two or more days, we call that conclusive evidence for pathological reflux,” Naik said. “However, despite this definitive diagnosis it is important that providers determine if the patient presenting symptoms are reflux related.”
The new version also includes separate thresholds for testing patients on antisecretory therapy for pH or pH Impedance testing and establishes Los Angeles grades B, C and D esophagitis as conclusive evidence of GERD. The previous Lyon Consensus only recognized grades C and D.
Highly International
First created in 2018, the Lyon Consensus update was the collaborative work of 21 international specialists in GERD.
Naik said this new version goes a long way toward helping clinicians improve identification of patients with true pathological reflux and in ruling out others with symptoms that resemble GERD.
“These updated guidelines allow personalized therapy for patient symptoms to optimize GERD diagnosis and management,” Naik said.
