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Korean J Gastroenterol  <  Volume 74(6); 2019 <  Articles

Korean J Gastroenterol 2019; 74(6): 321-325  https://doi.org/10.4166/kjg.2019.74.6.321
A Review of Making the Modern Diagnosis of Gastrointestinal Reflux Disease: the Lyon Consensus
Tae-oh Kim and Hye-Kyung Jung
Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
Correspondence to: Hye-Kyung Jung, Department of Internal Medicine, College of Medicine, Ewha Womans University, 25 Magokdong-ro 2-gil, Gangseo-gu, Seoul 07804, Korea. Tel: +82-2-2650-2874, Fax: +82-2-2655-2874, E-mail: junghk@ewha.ac.kr, ORCID: https://orcid.org/0000-0002-6653-5214
Received: November 13, 2019; Revised: December 6, 2019; Accepted: December 11, 2019; Published online: December 25, 2019.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Gastroesophageal reflux disease (GERD) is diagnosed according to the medical history or in response to proton pump inhibitor therapy. However, the need for further testing is always appropriate. The decisive evidence for the current diagnosis of GERD is severe erosive esophagitis of Los Angeles grade C or D, long-segment Barrett’s mucosa or peptic strictures seen on endoscopy or an acid exposure time >6% on ambulatory pH or pH impedance monitoring. If ambulatory reflux monitoring correlates between reflux and the symptoms, then the diagnosis and treatment are certain. If it is difficult to clearly diagnose this malady as seen upon endoscopy and ph/pH impedance monitoring, then this review recommends the biopsy findings, motor evaluation and novel impedance metrics. Novel impedance metrics include the baseline impedance and the post reflux swallow-induced peristaltic wave index. Therefore, making a future GERD diagnosis should focus on defining the patient's phenotype. The phenotype is determined by the level of reflux exposure, clearance efficacy, anatomy of the esophageal gastric junction, and the psychological state of the patient. The purpose of this review is to clarify the diagnostic guideline for GERD according to several test methods.
Keywords: Gastroesophageal reflux; Guideline; Diagnosis; Esophageal pH monitoring; Manometry

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