CINXE.COM

<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE html> <html lang="en" dir="ltr" version="HTML+RDFa+MathML 1.1" xmlns:dc="http://purl.org/dc/terms/" xmlns:foaf="http://xmlns.com/foaf/0.1/" xmlns:og="http://ogp.me/ns#" xmlns:rdfs="http://www.w3.org/2000/01/rdf-schema#" xmlns:sioc="http://rdfs.org/sioc/ns#" xmlns:sioct="http://rdfs.org/sioc/types#" xmlns:skos="http://www.w3.org/2004/02/skos/core#" xmlns:xsd="http://www.w3.org/2001/XMLSchema#" xmlns:mml="http://www.w3.org/1998/Math/MathML"> <head profile="http://www.w3.org/1999/xhtml/vocab">  <link rel="dns-prefetch" href="//securepubads.g.doubleclick.net" /> <link rel="dns-prefetch" href="//scholar.google.com" /> <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> <script>window.dataLayer = window.dataLayer || [];window.dataLayer.push({"page":{"hwTitle":"Updates to the modern diagnosis of GERD: Lyon consensus 2.0","hwUrl":"https://gut.bmj.com/content/73/2/361","hwPath":"/content/73/2/361.citation-tools","hwType":"journal page"},"user":{"hwMemberID":"","hwLoggedIntoInstitutionID":"","hwLoggedIntoInstitution":"","hwAccessUsageTerms":"guest","hwRegisteredUser":"no","hwHasFullTextAccess":"yes","hwEntitled":"no","mail":"e3b0c44298fc1c149afbf4c8996fb92427ae41e4649b934ca495991b7852b855"},"content":{"hwIssueDate":"2024-02-01","hwIssueDateTime":"2024-02-01 00:00:00","hwPublicationDate":"2024-01-05","hwPublicationDateTime":"2024-01-05 00:45:59","hwNlmArticleType":"review-article","hwDOI":"10.1136/gutjnl-2023-330616","hwAuthors":"C Prakash Gyawali,Rena Yadlapati,Ronnie Fass,David Katzka,John Pandolfino,Edoardo Savarino,Daniel Sifrim,Stuart Spechler,Frank Zerbib,Mark R Fox,Shobna Bhatia,Nicola de Bortoli,Yu Kyung Cho,Daniel Cisternas,Chien-Lin Chen,Charles Cock,Albis Hani,Jose Maria Remes Troche,Yinglian Xiao,Michael F Vaezi,Sabine Roman","hwContributors":"","hwIsEarlyRelease":"no","hwEissn":"1468-3288","hwPissn":"0017-5749","hwVolume":"73","hwIssue":"2","hwArticleType":"Recent advances in clinical practice","hwTabView":"citation-tools","hwViewType":"full","hwAccessType":"OpenAccess","hwOpenAccess":"yes","hwFreeAccess":"yes","hwTaxonomy":"GUT Recent advances in clinical practice|Open access","hwCorpusCode":"gutjnl","hwType":"article","hwSubtitle":null,"hwOverline":null,"hwPisaId":"gutjnl;73/2/361","hwFirstPage":"361","hwLastPage":"371","hwIsLatestVersion":"yes","hwIsCurrentIssue":"no","hwIsOpenIssue":"no","hwHasFullText":"yes","hwHasPDF":"yes","hwParentTitle":"Gut: 73 (2)","hwElectronicPubDate":"2024-01-05","hwElectronicPubDateTime":"2024-01-05 00:45:59"}}); //--><!]]></script> <meta name="viewport" content="width=device-width, initial-scale=1" /> <link rel="shortcut icon" href="https://gut.bmj.com/sites/default/themes/bmjj/favicon.ico" type="image/vnd.microsoft.icon" /> <link rel="canonical" href="https://gut.bmj.com/content/73/2/361" /> <meta name="Generator" content="Drupal 7 (http://drupal.org)" /> <link rel="alternate" type="application/pdf" title="Full Text (PDF)" href="/content/73/2/361.full.pdf" /> <link rel="alternate" type="text/plain" title="Full Text (Plain)" href="/content/73/2/361.full.txt" /> <link rel="alternate" type="application/vnd.ms-powerpoint" title="Powerpoint" href="/content/73/2/361.ppt" /> <meta name="issue_cover_image" content="https://gut.bmj.com/sites/default/files/highwire/gutjnl/73/2.cover-source.jpg" /> <meta name="type" content="article" /> <meta name="category" content="review-article" /> <meta name="HW.identifier" content="/gutjnl/73/2/361.atom" /> <meta name="HW.pisa" content="gutjnl;73/2/361" /> <meta name="DC.Format" content="text/html" /> <meta name="DC.Language" content="en" /> <meta name="DC.Title" content="Updates to the modern diagnosis of GERD: Lyon consensus 2.0" /> <meta name="DC.Identifier" content="10.1136/gutjnl-2023-330616" /> <meta name="DC.Date" content="2024-02-01" /> <meta name="DC.Publisher" content="BMJ Publishing Group" /> <meta name="DC.Rights" content="漏 Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/." /> <meta name="DC.AccessRights" content="open-access" /> <meta name="DC.Description" content="The Lyon Consensus provides conclusive criteria for and against the diagnosis of gastro-oesophageal reflux disease (GERD), and adjunctive metrics that consolidate or refute GERD diagnosis when primary criteria are borderline or inconclusive. An international core and working group was assembled to evaluate research since publication of the original Lyon Consensus, and to vote on statements collaboratively developed to update criteria. The Lyon Consensus 2.0 provides a modern definition of actionable GERD, where evidence from oesophageal testing supports revising, escalating or personalising GERD management for the symptomatic patient. Symptoms that have a high versus low likelihood of relationship to reflux episodes are described. Unproven versus proven GERD define diagnostic strategies and testing options. Patients with no prior GERD evidence (unproven GERD) are studied using prolonged wireless pH monitoring or catheter-based pH or pH-monitoring off antisecretory medication, while patients with conclusive GERD evidence (proven GERD) and persisting symptoms are evaluated using pH-impedance monitoring while on optimised antisecretory therapy. The major changes from the original Lyon Consensus criteria include establishment of Los Angeles grade B oesophagitis as conclusive GERD evidence, description of metrics and thresholds to be used with prolonged wireless pH monitoring, and inclusion of parameters useful in diagnosis of refractory GERD when testing is performed on antisecretory therapy in proven GERD. Criteria that have not performed well in the diagnosis of actionable GERD have been retired. Personalisation of investigation and management to each patient鈥檚 unique presentation will optimise GERD diagnosis and management." /> <meta name="DC.Contributor" content="C Prakash Gyawali" /> <meta name="DC.Contributor" content="Rena Yadlapati" /> <meta name="DC.Contributor" content="Ronnie Fass" /> <meta name="DC.Contributor" content="David Katzka" /> <meta name="DC.Contributor" content="John Pandolfino" /> <meta name="DC.Contributor" content="Edoardo Savarino" /> <meta name="DC.Contributor" content="Daniel Sifrim" /> <meta name="DC.Contributor" content="Stuart Spechler" /> <meta name="DC.Contributor" content="Frank Zerbib" /> <meta name="DC.Contributor" content="Mark R Fox" /> <meta name="DC.Contributor" content="Shobna Bhatia" /> <meta name="DC.Contributor" content="Nicola de Bortoli" /> <meta name="DC.Contributor" content="Yu Kyung Cho" /> <meta name="DC.Contributor" content="Daniel Cisternas" /> <meta name="DC.Contributor" content="Chien-Lin Chen" /> <meta name="DC.Contributor" content="Charles Cock" /> <meta name="DC.Contributor" content="Albis Hani" /> <meta name="DC.Contributor" content="Jose Maria Remes Troche" /> <meta name="DC.Contributor" content="Yinglian Xiao" /> <meta name="DC.Contributor" content="Michael F Vaezi" /> <meta name="DC.Contributor" content="Sabine Roman" /> <meta name="article:published_time" content="2024-02-01" /> <meta name="article:section" content="Recent advances in clinical practice" /> <meta name="citation_title" content="Updates to the modern diagnosis of GERD: Lyon consensus 2.0" /> <meta name="citation_abstract" lang="en" content="<p>The Lyon Consensus provides conclusive criteria for and against the diagnosis of gastro-oesophageal reflux disease (GERD), and adjunctive metrics that consolidate or refute GERD diagnosis when primary criteria are borderline or inconclusive. An international core and working group was assembled to evaluate research since publication of the original Lyon Consensus, and to vote on statements collaboratively developed to update criteria. The Lyon Consensus 2.0 provides a modern definition of actionable GERD, where evidence from oesophageal testing supports revising, escalating or personalising GERD management for the symptomatic patient. Symptoms that have a high versus low likelihood of relationship to reflux episodes are described. Unproven versus proven GERD define diagnostic strategies and testing options. Patients with no prior GERD evidence (unproven GERD) are studied using prolonged wireless pH monitoring or catheter-based pH or pH-monitoring off antisecretory medication, while patients with conclusive GERD evidence (proven GERD) and persisting symptoms are evaluated using pH-impedance monitoring while on optimised antisecretory therapy. The major changes from the original Lyon Consensus criteria include establishment of Los Angeles grade B oesophagitis as conclusive GERD evidence, description of metrics and thresholds to be used with prolonged wireless pH monitoring, and inclusion of parameters useful in diagnosis of refractory GERD when testing is performed on antisecretory therapy in proven GERD. Criteria that have not performed well in the diagnosis of actionable GERD have been retired. Personalisation of investigation and management to each patient鈥檚 unique presentation will optimise GERD diagnosis and management.</p>" /> <meta name="citation_journal_title" content="Gut" /> <meta name="citation_publisher" content="BMJ Publishing Group" /> <meta name="citation_publication_date" content="2024/02/01" /> <meta name="citation_mjid" content="gutjnl;73/2/361" /> <meta name="citation_id" content="73/2/361" /> <meta name="citation_public_url" content="https://gut.bmj.com/content/73/2/361" /> <meta name="citation_abstract_html_url" content="https://gut.bmj.com/content/73/2/361.abstract" /> <meta name="citation_full_html_url" content="https://gut.bmj.com/content/73/2/361.full" /> <meta name="citation_pdf_url" content="https://gut.bmj.com/content/gutjnl/73/2/361.full.pdf" /> <meta name="citation_issn" content="0017-5749" /> <meta name="citation_issn" content="1468-3288" /> <meta name="citation_doi" content="10.1136/gutjnl-2023-330616" /> <meta name="citation_pmid" content="37734911" /> <meta name="citation_volume" content="73" /> <meta name="citation_issue" content="2" /> <meta name="citation_article_type" content="Review Article" /> <meta name="citation_section" content="Recent advances in clinical practice" /> <meta name="citation_firstpage" content="361" /> <meta name="citation_lastpage" content="371" /> <meta name="citation_access" content="all" /> <meta name="citation_author" content="C Prakash Gyawali" /> <meta name="citation_author_institution" content="Division of Gastroenterology" /> <meta name="citation_author_institution" content="Washington University School of Medicine" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0002-3388-0660" /> <meta name="citation_author" content="Rena Yadlapati" /> <meta name="citation_author_institution" content="Division of Gastroenterology" /> <meta name="citation_author_institution" content="University of California in San Diego" /> <meta name="citation_author" content="Ronnie Fass" /> <meta name="citation_author_institution" content="Medicine/Section of Gastroenterology" /> <meta name="citation_author_institution" content="Case Western Reserve University" /> <meta name="citation_author" content="David Katzka" /> <meta name="citation_author_institution" content="Gastroenterology and Hepatology" /> <meta name="citation_author_institution" content="Columbia University" /> <meta name="citation_author" content="John Pandolfino" /> <meta name="citation_author_institution" content="Gastroenterology and Hepatology" /> <meta name="citation_author_institution" content="Northwestern University Feinberg School of Medicine" /> <meta name="citation_author" content="Edoardo Savarino" /> <meta name="citation_author_institution" content="Department of Surgery, Oncology and Gastroenterology, Department of Medical and Surgical Specialties" /> <meta name="citation_author_institution" content="University of Padua" /> <meta name="citation_author" content="Daniel Sifrim" /> <meta name="citation_author_institution" content="Blizard Institute" /> <meta name="citation_author_institution" content="Barts and The London School of Medicine and Dentistry" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0002-4894-0523" /> <meta name="citation_author" content="Stuart Spechler" /> <meta name="citation_author_institution" content="Division of Gastroenterology" /> <meta name="citation_author_institution" content="Baylor Scott and White North Texas" /> <meta name="citation_author" content="Frank Zerbib" /> <meta name="citation_author_institution" content="Gastroenterology" /> <meta name="citation_author_institution" content="CHU de Bordeaux" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0002-6802-2121" /> <meta name="citation_author" content="Mark R Fox" /> <meta name="citation_author_institution" content="Gastroenterology" /> <meta name="citation_author_institution" content="University of Zurich" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0003-4394-5584" /> <meta name="citation_author" content="Shobna Bhatia" /> <meta name="citation_author_institution" content="Gastroenterology" /> <meta name="citation_author_institution" content="NIMS University" /> <meta name="citation_author" content="Nicola de Bortoli" /> <meta name="citation_author_institution" content="Division of Gastroenterology" /> <meta name="citation_author_institution" content="University of Pisa" /> <meta name="citation_author" content="Yu Kyung Cho" /> <meta name="citation_author_institution" content="Gastroenterology" /> <meta name="citation_author_institution" content="Catholic University of Korea - Songsin Campus" /> <meta name="citation_author" content="Daniel Cisternas" /> <meta name="citation_author_institution" content="Digestive System Research Unit" /> <meta name="citation_author_institution" content="Universidad del Desarrollo Facultad de Medicina Cl铆nica Alemana" /> <meta name="citation_author" content="Chien-Lin Chen" /> <meta name="citation_author_institution" content="Department of Medicine" /> <meta name="citation_author_institution" content="Tzu Chi University" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0002-9084-8210" /> <meta name="citation_author" content="Charles Cock" /> <meta name="citation_author_institution" content="Department of Gastroenterology and Hepatology" /> <meta name="citation_author_institution" content="Flinders University" /> <meta name="citation_author" content="Albis Hani" /> <meta name="citation_author_institution" content="Gastroenterology Unit, Department of Medicine" /> <meta name="citation_author_institution" content="Pontificia Universidad Javeriana" /> <meta name="citation_author" content="Jose Maria Remes Troche" /> <meta name="citation_author_institution" content="Digestive Physiology and Motility Lab" /> <meta name="citation_author_institution" content="Veracruzana University" /> <meta name="citation_author" content="Yinglian Xiao" /> <meta name="citation_author_institution" content="Department of Gastroenterology" /> <meta name="citation_author_institution" content="Sun Yan-sen University of Medical Sciences" /> <meta name="citation_author" content="Michael F Vaezi" /> <meta name="citation_author_institution" content="Department of Medicine" /> <meta name="citation_author_institution" content="Vanderbilt University" /> <meta name="citation_author" content="Sabine Roman" /> <meta name="citation_author_institution" content="Department of Digestive Physiology" /> <meta name="citation_author_institution" content="Universite de Lyon" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0002-7798-7638" /> <meta name="citation_reference" content="citation_journal_title=Gut;citation_author=CP. Gyawali;citation_author=PJ. Kahrilas;citation_author=E. Savarino;citation_title=Modern diagnosis of GERD: the lyon consensus;citation_volume=67;citation_year=2018;citation_pmid=29437910;citation_doi=10.1136/gutjnl-2017-314722" /> <meta name="citation_reference" content="citation_journal_title=The American journal of gastroenterology;citation_journal_abbrev=Am J Gastroenterol;citation_author=N. Vakil;citation_author=SV. van Zanten;citation_author=P. Kahrilas;citation_title=The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus.;citation_pages=1900-1920;citation_volume=101;citation_year=2006;citation_issue=8;citation_pmid=16928254;citation_doi=10.1111/j.1572-0241.2006.00630.x" /> <meta name="citation_reference" content="citation_journal_title=Clinical Gastroenterology and Hepatology;citation_author=R. Yadlapati;citation_author=CP. Gyawali;citation_author=JE. Pandolfino;citation_title=AGA clinical practice update on the personalized approach to the evaluation and management of GERD: expert review;citation_pages=984-994;citation_volume=20;citation_year=2022" /> <meta name="citation_reference" content="citation_journal_title=Gut;citation_journal_abbrev=Gut;citation_author=J. Dent;citation_author=N. Vakil;citation_author=R. Jones;citation_title=Accuracy of the diagnosis of GORD by questionnaire, physicians and a trial of proton pump inhibitor treatment: the Diamond Study;citation_pages=714-721;citation_volume=59;citation_year=2010;citation_issue=6;citation_pmid=20551454;citation_doi=10.1136/gut.2009.200063" /> <meta name="citation_reference" content="citation_journal_title=J Clin Gastroenterol;citation_author=S. Ghoneim;citation_author=J. Wang;citation_author=N. El Hage Chehade;citation_title=Diagnostic accuracy of the proton pump inhibitor test in gastroesophageal reflux disease and noncardiac chest pain: a systematic review and meta-analysis;citation_pages=380-8;citation_volume=57;citation_year=2023" /> <meta name="citation_reference" content="citation_journal_title=Am J Gastroenterol;citation_author=DO. Francis;citation_author=JA. Rymer;citation_author=JC. Slaughter;citation_title=High economic burden of caring for patients with suspected extraesophageal reflux;citation_pages=905-11;citation_volume=108;citation_year=2013;citation_pmid=23545710;citation_doi=10.1038/ajg.2013.69" /> <meta name="citation_reference" content="citation_journal_title=Eur J Intern Med;citation_author=V. Savarino;citation_author=P. Dulbecco;citation_author=N. de Bortoli;citation_title=The appropriate use of proton pump inhibitors (Ppis): need for a reappraisal;citation_pages=19-24;citation_volume=37;citation_year=2017;citation_pmid=27784575;citation_doi=10.1016/j.ejim.2016.10.007" /> <meta name="citation_reference" content="citation_journal_title=Gastroenterology;citation_author=CP. Gyawali;citation_author=R. Fass;citation_title=Management of gastroesophageal reflux disease;citation_pages=302-18;citation_volume=154;citation_year=2018;citation_pmid=http://www.n" /> <meta name="citation_reference" content="citation_journal_title=Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus / I.S.D.E;citation_journal_abbrev=Dis Esophagus;citation_author=R. Fass;citation_author=SR. Achem;citation_title=Noncardiac chest pain: diagnostic evaluation.;citation_pages=89-101;citation_volume=25;citation_year=2012;citation_issue=2;citation_pmid=21777340" /> <meta name="citation_reference" content="citation_journal_title=Gut;citation_author=G. Boeckxstaens;citation_author=HB. El-Serag;citation_author=AJPM. Smout;citation_title=Symptomatic reflux disease: the present, the past and the future;citation_volume=63;citation_year=2014;citation_pmid=24607936;citation_doi=10.1136/gutjnl-2013-306393" /> <meta name="citation_reference" content="citation_journal_title=Gut;citation_journal_abbrev=Gut;citation_author=R. Fass;citation_author=G. Tougas;citation_title=Functional heartburn: the stimulus, the pain, and the brain;citation_pages=885-892;citation_volume=51;citation_year=2002;citation_issue=6;citation_pmid=12427796;citation_doi=10.1136/gut.51.6.885" /> <meta name="citation_reference" content="citation_journal_title=The American journal of gastroenterology;citation_journal_abbrev=Am J Gastroenterol;citation_author=PJ. Kahrilas;citation_author=CW. Howden;citation_author=N. Hughes;citation_title=Response of regurgitation to proton pump inhibitor therapy in clinical trials of gastroesophageal reflux disease.;citation_pages=1419-1425;citation_volume=106;citation_year=2011;citation_issue=8;citation_pmid=21537361;citation_doi=10.1038/ajg.2011.146" /> <meta name="citation_reference" content="citation_journal_title=Gastroenterology;citation_journal_abbrev=Gastroenterology;citation_author=MF. Vela;citation_author=L. Camacho-Lobato;citation_author=R. Srinivasan;citation_title=Simultaneous Intraesophageal Impedance and pH Measurement of Acid and Nonacid Gastroesophageal Reflux: Effect of Omeprazole;citation_pages=1599-1606;citation_volume=120;citation_year=2001;citation_issue=7;citation_pmid=11375942;citation_doi=10.1053/gast.2001.24840" /> <meta name="citation_reference" content="citation_journal_title=Gut;citation_author=PJ. Kahrilas;citation_author=A. Jonsson;citation_author=H. Denison;citation_title=Impact of regurgitation on health-related quality of life in gastro-oesophageal reflux disease before and after short-term potent acid suppression therapy;citation_volume=63;citation_year=2014;citation_pmid=23831734;citation_doi=10.1136/gutjnl-2013-304883" /> <meta name="citation_reference" content="citation_journal_title=Aliment Pharmacol Ther;citation_author=PJ. Kahrilas;citation_author=CW. Howden;citation_author=B. Wernersson;citation_title=Impact of persistent, frequent regurgitation on quality of life in Heartburn responders treated with acid suppression: a multinational primary care study;citation_pages=1005-10;citation_volume=37;citation_year=2013" /> <meta name="citation_reference" content="citation_journal_title=J Clin Gastroenterol;citation_author=BF. Kessing;citation_author=AJPM. Smout;citation_author=AJ. Bredenoord;citation_title=Current diagnosis and management of the rumination syndrome;citation_pages=478-83;citation_volume=48;citation_year=2014" /> <meta name="citation_reference" content="citation_journal_title=Am J Gastroenterol;citation_author=K. Nakagawa;citation_author=A. Sawada;citation_author=Y. Hoshikawa;citation_title=Persistent postprandial regurgitation vs rumination in patients with refractory gastroesophageal reflux disease symptoms: identification of a distinct rumination pattern using ambulatory impedance-pH monitoring;citation_pages=1248-55;citation_volume=114;citation_year=2019" /> <meta name="citation_reference" content="citation_journal_title=Am J Gastroenterol;citation_author=HB. Murray;citation_author=AS. Juarascio;citation_author=C. Di Lorenzo;citation_title=Diagnosis and treatment of rumination syndrome: a critical review;citation_pages=562-78;citation_volume=114;citation_year=2019;citation_pmid=http://www.n" /> <meta name="citation_reference" content="citation_journal_title=Am J Gastroenterol;citation_author=BF. Kessing;citation_author=AJ. Bredenoord;citation_author=A. Smout;citation_title=The pathophysiology, diagnosis and treatment of excessive belching symptoms;citation_pages=1196-203;citation_volume=109;citation_year=2014;citation_pmid=25001253;citation_doi=10.1038/ajg.2014.165" /> <meta name="citation_reference" content="citation_journal_title=Nat Rev Dis Primers;citation_title=Cough hypersensitivity and chronic cough;citation_volume=8;citation_year=2022" /> <meta name="citation_reference" content="citation_journal_title=Eur Respir J;citation_author=E. Savarino;citation_author=R. Carbone;citation_author=E. Marabotto;citation_title=Gastro-Oesophageal reflux and gastric aspiration in idiopathic pulmonary fibrosis patients;citation_volume=42;citation_year=2013;citation_pmid=23471347;citation_doi=10.1183/09031936.00101212" /> <meta name="citation_reference" content="citation_journal_title=Am J Gastroenterol;citation_author=V. Rangan;citation_author=LF. Borges;citation_author=W-K. Lo;citation_title=Novel advanced impedance metrics on impedance-pH testing predict lung function decline in idiopathic pulmonary fibrosis;citation_pages=405-12;citation_volume=117;citation_year=2022" /> <meta name="citation_reference" content="citation_journal_title=BMJ Open;citation_title=Randomised trials of proton pump inhibitors for gastro-oesophageal reflux disease in patients with asthma: an updated systematic review and meta-analysis;citation_volume=11;citation_year=2021" /> <meta name="citation_reference" content="citation_journal_title=Neurogastroenterol Motil;citation_title=Diagnosis and management of globus sensation: a clinical challenge;citation_volume=32;citation_year=2020" /> <meta name="citation_reference" content="citation_journal_title=The Laryngoscope;citation_journal_abbrev=Laryngoscope;citation_author=MF. Vaezi;citation_author=JE. Richter;citation_author=CR. Stasney;citation_title=Treatment of chronic posterior laryngitis with esomeprazole.;citation_pages=254-260;citation_volume=116;citation_year=2006;citation_issue=2;citation_pmid=16467715;citation_doi=10.1097/01.mlg.0000192173.00498.ba" /> <meta name="citation_reference" content="citation_journal_title=Am J Gastroenterol;citation_author=M-W. Wong;citation_author=S-H. Hsiao;citation_author=J-H. Wang;citation_title=Esophageal hypervigilance and visceral anxiety contribute to symptom severity of laryngopharyngeal reflux;citation_pages=786-93;citation_volume=118;citation_year=2023" /> <meta name="citation_reference" content="citation_journal_title=Neurogastroenterol Motil;citation_author=C. Pleyer;citation_author=H. Bittner;citation_author=GR. Locke;citation_title=Overdiagnosis of gastro-esophageal reflux disease and underdiagnosis of functional dyspepsia in a USA community;citation_pages=1163-71;citation_volume=26;citation_year=2014;citation_pmid=http://www.n" /> <meta name="citation_reference" content="citation_journal_title=Am J Gastroenterol;citation_author=P. Visaggi;citation_author=G. Del Corso;citation_author=CP. Gyawali;citation_title=Ambulatory pH-impedance findings confirm that grade B Esophagitis provides objective diagnosis of gastroesophageal reflux disease;citation_pages=794-801;citation_volume=118;citation_year=2023" /> <meta name="citation_reference" content="citation_journal_title=Gut;citation_author=R-I. Rusu;citation_author=MR. Fox;citation_author=E. Tucker;citation_title=Validation of the Lyon classification for GORD diagnosis: acid exposure time assessed by prolonged Wireless pH-monitoring in healthy controls and patients with erosive oesophagitis;citation_volume=70;citation_year=2021;citation_pmid=33579789;citation_doi=10.1136/gutjnl-2020-323798" /> <meta name="citation_reference" content="citation_journal_title=Gut;citation_author=LR. Lundell;citation_author=J. Dent;citation_author=JR. Bennett;citation_title=Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification;citation_volume=45;citation_year=1999;citation_pmid=10403727;citation_doi=10.1136/gut.45.2.172" /> <meta name="citation_reference" content="citation_journal_title=Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society;citation_journal_abbrev=Neurogastroenterol Motil;citation_author=E. Savarino;citation_author=P. Zentilin;citation_author=M. Frazzoni;citation_title=Characteristics of gastro-esophageal reflux episodes in Barrett's esophagus, erosive esophagitis and healthy volunteers.;citation_pages=1061-e280;citation_volume=22;citation_year=2010;citation_issue=10;citation_pmid=20557468" /> <meta name="citation_reference" content="citation_journal_title=Gastroenterology;citation_journal_abbrev=Gastroenterology;citation_author=D. Armstrong;citation_author=JR. Bennett;citation_author=AL. Blum;citation_title=The endoscopic assessment of esophagitis: a progress report on observer agreement;citation_pages=85-92;citation_volume=111;citation_year=1996;citation_issue=1;citation_pmid=8698230;citation_doi=10.1053/gast.1996.v111.pm8698230" /> <meta name="citation_reference" content="citation_journal_title=Digestion;citation_journal_abbrev=Digestion;citation_author=T. Takashima;citation_author=R. Iwakiri;citation_author=Y. Sakata;citation_title=Endoscopic reflux esophagitis and Helicobacter pylori infection in young healthy Japanese volunteers.;citation_pages=55-58;citation_volume=86;citation_year=2012;citation_issue=1;citation_pmid=22722701;citation_doi=10.1159/000338849" /> <meta name="citation_reference" content="citation_journal_title=Gut;citation_author=RM. Zagari;citation_author=L. Fuccio;citation_author=M-A. Wallander;citation_title=Gastro-Oesophageal reflux symptoms, oesophagitis and Barrett鈥檚 oesophagus in the general population: the loiano-monghidoro study;citation_volume=57;citation_year=2008;citation_pmid=18424568;citation_doi=10.1136/gut.2007.145177" /> <meta name="citation_reference" content="citation_journal_title=Neurogastroenterol Motil;citation_title=Overlap of functional Heartburn and reflux hypersensitivity with proven gastroesophageal reflux disease;citation_volume=33;citation_year=2021" /> <meta name="citation_reference" content="citation_journal_title=Gastroenterology;citation_journal_abbrev=Gastroenterology;citation_author=N. Chiba;citation_author=CJ. De Gara;citation_author=JM. Wilkinson;citation_title=Speed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: a meta-analysis;citation_pages=1798-1810;citation_volume=112;citation_year=1997;citation_issue=6;citation_pmid=9178669;citation_doi=10.1053/gast.1997.v112.pm9178669" /> <meta name="citation_reference" content="citation_journal_title=Cochrane Database Syst Rev;citation_title=Deprescribing versus continuation of chronic proton pump inhibitor use in adults;citation_volume=3;citation_year=2017" /> <meta name="citation_reference" content="citation_journal_title=JAMA;citation_author=KB. Dunbar;citation_author=AT. Agoston;citation_author=RD. Odze;citation_title=Association of acute gastroesophageal reflux disease with esophageal histologic changes;citation_pages=2104-12;citation_volume=315;citation_year=2016;citation_pmid=27187303;citation_doi=10.1001/jama.2016.5657" /> <meta name="citation_reference" content="citation_journal_title=Neurogastroenterol Motil;citation_title=ESNM/ANMS consensus paper: diagnosis and management of refractory gastro-esophageal reflux disease;citation_volume=33;citation_year=2021" /> <meta name="citation_reference" content="citation_journal_title=The American journal of gastroenterology;citation_journal_abbrev=Am J Gastroenterol;citation_author=JE. Pandolfino;citation_author=JE. Richter;citation_author=T. Ours;citation_title=Ambulatory esophageal pH monitoring using a wireless system.;citation_pages=740-749;citation_volume=98;citation_year=2003;citation_issue=4;citation_pmid=12738450;citation_doi=10.1111/j.1572-0241.2003.07398.x" /> <meta name="citation_reference" content="citation_journal_title=Dis Esophagus;citation_title=Trajectory assessment is useful when day-to-day esophageal acid exposure varies in prolonged wireless pH monitoring;citation_volume=32;citation_year=2019" /> <meta name="citation_reference" content="citation_journal_title=Gastroenterology;citation_author=R. Yadlapati;citation_author=M. Masihi;citation_author=CP. Gyawali;citation_title=Ambulatory reflux monitoring guides proton pump inhibitor discontinuation in patients with gastroesophageal reflux symptoms: a clinical trial;citation_pages=174-82;citation_volume=160;citation_year=2021;citation_pmid=http://www.n;citation_doi=10.1053/j.gastro.2020.09.013" /> <meta name="citation_reference" content="citation_journal_title=J Neurogastroenterol Motil;citation_author=R. Penagini;citation_author=R. Sweis;citation_author=A. Mauro;citation_title=Inconsistency in the diagnosis of functional heartburn: usefulness of prolonged wireless pH monitoring in patients with proton pump inhibitor refractory gastroesophageal reflux disease;citation_pages=265-72;citation_volume=21;citation_year=2015;citation_pmid=http://www.n;citation_doi=10.5056/jnm14075" /> <meta name="citation_reference" content="citation_journal_title=Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society;citation_journal_abbrev=Neurogastroenterol Motil;citation_author=R. Sweis;citation_author=M. Fox;citation_author=A. Anggiansah;citation_title=Prolonged, wireless pH-studies have a high diagnostic yield in patients with reflux symptoms and negative 24-h catheter-based pH-studies.;citation_pages=419-426;citation_volume=23;citation_year=2011;citation_issue=5;citation_pmid=21235685;citation_doi=10.1111/j.1365-2982.2010.01663.x" /> <meta name="citation_reference" content="citation_journal_title=Clin Gastroenterol Hepatol;citation_author=S. Hasak;citation_author=R. Yadlapati;citation_author=O. Altayar;citation_title=Prolonged Wireless pH monitoring in patients with persistent reflux symptoms despite proton pump inhibitor therapy;citation_pages=2912-9;citation_volume=18;citation_year=2020;citation_pmid=http://www.n;citation_doi=10.1016/j.cgh.2020.01.031" /> <meta name="citation_reference" content="citation_journal_title=Am J Gastroenterol;citation_author=R. Yadlapati;citation_author=CP. Gyawali;citation_author=M. Masihi;citation_title=Optimal Wireless reflux monitoring metrics to predict discontinuation of proton pump inhibitor therapy;citation_pages=1573-82;citation_volume=117;citation_year=2022;citation_pmid=35973148;citation_doi=10.14309/ajg.0000000000001871" /> <meta name="citation_reference" content="citation_journal_title=Gut;citation_journal_abbrev=Gut;citation_author=D. Sifrim;citation_author=D. Castell;citation_author=J. Dent;citation_title=Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux;citation_pages=1024-1031;citation_volume=53;citation_year=2004;citation_issue=7;citation_pmid=15194656;citation_doi=10.1136/gut.2003.033290" /> <meta name="citation_reference" content="citation_journal_title=Gut;citation_author=BD. Rogers;citation_author=LR. Valdovinos;citation_author=MD. Crowell;citation_title=Number of reflux episodes on pH-impedance monitoring associates with improved symptom outcome and treatment satisfaction in gastro-oesophageal reflux disease (GERD) patients with regurgitation;citation_volume=70;citation_year=2021;citation_pmid=32467089;citation_doi=10.1136/gutjnl-2020-321395" /> <meta name="citation_reference" content="citation_journal_title=Clinical Gastroenterology and Hepatology;citation_author=CP. Gyawali;citation_author=B. Rogers;citation_author=M. Frazzoni;citation_title=Inter-reviewer variability in interpretation of pH-impedance studies: the Wingate consensus;citation_pages=1976-1978;citation_volume=19;citation_year=2021" /> <meta name="citation_reference" content="citation_journal_title=Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver;citation_journal_abbrev=Dig Liver Dis;citation_author=E. Savarino;citation_author=E. Marabotto;citation_author=P. Zentilin;citation_title=The added value of impedance-pH monitoring to Rome III criteria in distinguishing functional heartburn from non-erosive reflux disease.;citation_pages=542-547;citation_volume=43;citation_year=2011;citation_issue=7;citation_pmid=21376679;citation_doi=10.1016/j.dld.2011.01.016" /> <meta name="citation_reference" content="citation_journal_title=Gut;citation_author=F. Zerbib;citation_author=A. Duriez;citation_author=S. Roman;citation_title=Determinants of gastro-oesophageal reflux perception in patients with persistent symptoms despite proton pump inhibitors;citation_volume=57;citation_year=2008;citation_pmid=17951358;citation_doi=10.1136/gut.2007.133470" /> <meta name="citation_reference" content="citation_journal_title=Neurogastroenterol Motil;citation_author=L. Frazzoni;citation_author=M. Frazzoni;citation_author=N. de Bortoli;citation_title=Postreflux swallow-induced peristaltic wave index and nocturnal baseline impedance can link PPI-responsive heartburn to reflux better than acid exposure time;citation_pages=11;citation_volume=29;citation_year=2017" /> <meta name="citation_reference" content="citation_journal_title=Aliment Pharmacol Ther;citation_author=M. Frazzoni;citation_author=L. Frazzoni;citation_author=M. Ribolsi;citation_title=Applying lyon consensus criteria in the work-up of patients with proton pump inhibitory-refractory heartburn;citation_pages=1423-30;citation_volume=55;citation_year=2022" /> <meta name="citation_reference" content="citation_journal_title=Clin Gastroenterol Hepatol;citation_author=A. Rengarajan;citation_author=E. Savarino;citation_author=M. Della Coletta;citation_title=Mean nocturnal baseline impedance correlates with symptom outcome when acid exposure time is inconclusive on esophageal reflux monitoring;citation_pages=589-95;citation_volume=18;citation_year=2020" /> <meta name="citation_reference" content="citation_journal_title=Dig Liver Dis;citation_author=M. Frazzoni;citation_author=H. Bertani;citation_author=R. Manta;citation_title=Impairment of chemical clearance is relevant to the pathogenesis of refractory reflux oesophagitis;citation_pages=596-602;citation_volume=46;citation_year=2014;citation_pmid=http://www.n" /> <meta name="citation_reference" content="citation_journal_title=Am J Gastroenterol;citation_author=M. Frazzoni;citation_author=L. Frazzoni;citation_author=S. Tolone;citation_title=Lack of improvement of impaired chemical clearance characterizes PPI-refractory reflux-related heartburn;citation_pages=670-6;citation_volume=113;citation_year=2018;citation_pmid=http://www.n;citation_doi=10.1038/s41395-018-0044-5" /> <meta name="citation_reference" content="citation_journal_title=J Heart Lung Transplant;citation_author=W-K. Lo;citation_author=R. Burakoff;citation_author=HJ. Goldberg;citation_title=Pre-transplant impedance measures of reflux are associated with early allograft injury after lung transplantation;citation_pages=26-35;citation_volume=34;citation_year=2015" /> <meta name="citation_reference" content="citation_journal_abbrev=J Dig Dis;citation_author=D. Ang;citation_author=TL. Ang;citation_author=EK. Teo;citation_title=Is impedance pH monitoring superior to the conventional 24-h pH meter in the evaluation of patients with laryngorespiratory symptoms suspected to be due to gastroesophageal reflux disease?;citation_pages=341-348;citation_volume=12;citation_year=2011;citation_issue=5;citation_pmid=21955426" /> <meta name="citation_reference" content="citation_journal_title=Aliment Pharmacol Ther;citation_author=M. Ribolsi;citation_author=E. Savarino;citation_author=N. De Bortoli;citation_title=Reflux pattern and role of impedance-pH variables in predicting PPI response in patients with suspected GERD-related chronic cough;citation_pages=966-73;citation_volume=40;citation_year=2014;citation_pmid=25109844;citation_doi=10.1111/apt.12919" /> <meta name="citation_reference" content="citation_journal_title=World journal of gastroenterology : WJG;citation_journal_abbrev=World J Gastroenterol;citation_author=N. de Bortoli;citation_author=A. Nacci;citation_author=E. Savarino;citation_title=How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related?;citation_pages=4363-4370;citation_volume=18;citation_year=2012;citation_issue=32;citation_pmid=22969200;citation_doi=10.3748/wjg.v18.i32.4363" /> <meta name="citation_reference" content="citation_journal_title=Laryngoscope;citation_author=TL. Carroll;citation_author=A. Werner;citation_author=K. Nahikian;citation_title=Rethinking the laryngopharyngeal reflux treatment algorithm: evaluating an alternate empiric dosing regimen and considering up-front, pH-impedance, and manometry testing to minimize cost in treating suspect laryngopharyngeal reflux disease;citation_pages=S1-13;citation_volume=127 Suppl 6;citation_year=2017" /> <meta name="citation_reference" content="citation_journal_title=Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association;citation_journal_abbrev=Clin Gastroenterol Hepatol;citation_author=GJM. Hemmink;citation_author=BLAM. Weusten;citation_author=AJ. Bredenoord;citation_title=Aerophagia: excessive air swallowing demonstrated by esophageal impedance monitoring.;citation_pages=1127-1129;citation_volume=7;citation_year=2009;citation_issue=10;citation_pmid=19602452" /> <meta name="citation_reference" content="citation_journal_title=Clin Gastroenterol Hepatol;citation_author=A. Sawada;citation_author=M. Guzman;citation_author=K. Nikaki;citation_title=Identification of different phenotypes of esophageal reflux hypersensitivity and implications for treatment;citation_pages=690-8;citation_volume=19;citation_year=2021" /> <meta name="citation_reference" content="citation_journal_title=The American journal of gastroenterology;citation_journal_abbrev=Am J Gastroenterol;citation_author=S. Charbel;citation_author=F. Khandwala;citation_author=MF. Vaezi;citation_title=The role of esophageal pH monitoring in symptomatic patients on PPI therapy.;citation_pages=283-289;citation_volume=100;citation_year=2005;citation_issue=2;citation_pmid=15667483;citation_doi=10.1111/j.1572-0241.2005.41210.x" /> <meta name="citation_reference" content="citation_journal_title=Gastroenterology;citation_author=CP. Gyawali;citation_author=R. Tutuian;citation_author=F. Zerbib;citation_title=Value of pH impedance monitoring while on twice-daily proton pump inhibitor therapy to identify need for escalation of reflux management;citation_pages=1412-22;citation_volume=161;citation_year=2021" /> <meta name="citation_reference" content="citation_journal_title=Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association;citation_journal_abbrev=Clin Gastroenterol Hepatol;citation_author=JM. Pritchett;citation_author=M. Aslam;citation_author=JC. Slaughter;citation_title=Efficacy of esophageal impedance/pH monitoring in patients with refractory gastroesophageal reflux disease, on and off therapy.;citation_pages=743-748;citation_volume=7;citation_year=2009;citation_issue=7;citation_pmid=19281866;citation_doi=10.1016/j.cgh.2009.02.022" /> <meta name="citation_reference" content="citation_journal_title=Neurogastroenterol Motil;citation_title=The added diagnostic value of postreflux swallow-induced peristaltic wave index and nocturnal baseline impedance in refractory reflux disease studied with on-therapy impedance-pH monitoring;citation_volume=29;citation_year=2017" /> <meta name="citation_reference" content="citation_journal_title=Neurogastroenterol Motil;citation_title=On-therapy impedance-pH monitoring can efficiently characterize PPI-refractory GERD and support treatment escalation;citation_volume=35;citation_year=2023" /> <meta name="citation_reference" content="citation_journal_title=N Engl J Med;citation_author=SJ. Spechler;citation_author=JG. Hunter;citation_author=KM. Jones;citation_title=Randomized trial of medical versus surgical treatment for refractory heartburn;citation_pages=1513-23;citation_volume=381;citation_year=2019;citation_pmid=http://www.n;citation_doi=10.1056/NEJMoa1811424" /> <meta name="citation_reference" content="citation_journal_title=Digestion;citation_journal_abbrev=Digestion;citation_author=M. Bajbouj;citation_author=V. Becker;citation_author=V. Phillip;citation_title=High-dose esomeprazole for treatment of symptomatic refractory gastroesophageal reflux disease--a prospective pH-metry/impedance-controlled study.;citation_pages=112-118;citation_volume=80;citation_year=2009;citation_issue=2;citation_pmid=19641320;citation_doi=10.1159/000221146" /> <meta name="citation_reference" content="citation_journal_title=Am J Gastroenterol;citation_author=CP. Gyawali;citation_author=DA. Carlson;citation_author=JW. Chen;citation_title=ACG clinical guidelines: clinical use of esophageal physiologic testing;citation_pages=1412-28;citation_volume=115;citation_year=2020;citation_pmid=http://www.n;citation_doi=10.14309/ajg.0000000000000734" /> <meta name="citation_reference" content="citation_journal_title=Gastroenterology;citation_author=Q. Aziz;citation_author=R. Fass;citation_author=CP. Gyawali;citation_title=ESOPHAGEAL DISORDERS;citation_pages=1368-79;citation_volume=150;citation_year=2016;citation_issue=6" /> <meta name="citation_reference" content="citation_journal_title=Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association;citation_journal_abbrev=Clin Gastroenterol Hepatol;citation_author=JC. Slaughter;citation_author=M. Goutte;citation_author=JA. Rymer;citation_title=Caution about overinterpretation of symptom indexes in reflux monitoring for refractory gastroesophageal reflux disease.;citation_pages=868-874;citation_volume=9;citation_year=2011;citation_issue=10;citation_pmid=21782769;citation_doi=10.1016/j.cgh.2011.07.009" /> <meta name="citation_reference" content="citation_journal_title=Digestive diseases and sciences;citation_journal_abbrev=Dig Dis Sci;citation_author=GJ. Wiener;citation_author=TM. Morgan;citation_author=JB. Copper;citation_title=Ambulatory 24-hour esophageal pH monitoring. Reproducibility and variability of pH parameters.;citation_pages=1127-1133;citation_volume=33;citation_year=1988;citation_issue=9;citation_pmid=3044715;citation_doi=10.1007/BF01535789" /> <meta name="citation_reference" content="citation_journal_title=Gut;citation_title=Normal values and regional differences in Oesophageal impedance-pH Metrics: a consensus analysis of impedance-pH studies from around the world;citation_year=2020" /> <meta name="citation_reference" content="citation_journal_title=J Gastrointest Surg;citation_author=M. Nikolic;citation_author=A. Matic;citation_author=J. Feka;citation_title=Expanded indication for magnetic sphincter augmentation: outcomes in weakly acidic reflux compared to standard GERD patients;citation_pages=532-41;citation_volume=26;citation_year=2022" /> <meta name="citation_reference" content="citation_journal_title=BMC Gastroenterol;citation_title=Optimization of impedance-measured reflux events in GORD utilizing acid exposure time;citation_volume=20;citation_year=2020" /> <meta name="citation_reference" content="citation_journal_title=Neurogastroenterol Motil;citation_author=I. Martinucci;citation_author=N. de Bortoli;citation_author=E. Savarino;citation_title=Esophageal baseline impedance levels in patients with pathophysiological characteristics of functional heartburn;citation_pages=546-55;citation_volume=26;citation_year=2014;citation_pmid=http://www.n;citation_doi=10.1111/nmo.12299" /> <meta name="citation_reference" content="citation_journal_title=J Neurogastroenterol Motil;citation_author=Y. Hoshikawa;citation_author=A. Sawada;citation_author=S. Sonmez;citation_title=Measurement of esophageal nocturnal baseline impedance: a simplified method;citation_pages=241-7;citation_volume=26;citation_year=2020;citation_pmid=http://www.n" /> <meta name="citation_reference" content="citation_journal_title=Gut;citation_author=L. Frazzoni;citation_author=M. Frazzoni;citation_author=N. De Bortoli;citation_title=Application of lyon consensus criteria for GORD diagnosis: evaluation of conventional and new impedance-pH parameters;citation_volume=71;citation_year=2022;citation_pmid=34376517;citation_doi=10.1136/gutjnl-2021-325531" /> <meta name="citation_reference" content="citation_journal_title=J Gastroenterol;citation_author=E. Savarino;citation_author=P. Zentilin;citation_author=L. Mastracci;citation_title=Microscopic esophagitis distinguishes patients with non-erosive reflux disease from those with functional heartburn;citation_pages=473-82;citation_volume=48;citation_year=2013;citation_pmid=23001252;citation_doi=10.1007/s00535-012-0672-2" /> <meta name="citation_reference" content="citation_journal_title=The American journal of gastroenterology;citation_journal_abbrev=Am J Gastroenterol;citation_author=MF. Vela;citation_author=BM. Craft;citation_author=N. Sharma;citation_title=Refractory heartburn: comparison of intercellular space diameter in documented GERD vs. functional heartburn.;citation_pages=844-850;citation_volume=106;citation_year=2011;citation_issue=5;citation_pmid=21179012;citation_doi=10.1038/ajg.2010.476" /> <meta name="citation_reference" content="citation_journal_title=Best Pract Res Clin Gastroenterol;citation_author=J. Krugmann;citation_author=H. Neumann;citation_author=M. Vieth;citation_title=What is the role of endoscopy and oesophageal biopsies in the management of GERD?;citation_pages=373-85;citation_volume=27;citation_year=2013;citation_doi=10.1016/j.bpg.2013.06.010" /> <meta name="citation_reference" content="citation_journal_title=Am J Gastroenterol;citation_author=RAB. Oude Nijhuis;citation_author=WL. Curvers;citation_author=M. van der Ende;citation_title=Utility of routine esophageal biopsies in patients with refractory reflux symptoms;citation_pages=816-20;citation_volume=116;citation_year=2021" /> <meta name="citation_reference" content="citation_journal_title=Gastroenterology;citation_author=F. Ates;citation_author=ES. Yuksel;citation_author=T. Higginbotham;citation_title=Mucosal impedance discriminates GERD from non-GERD conditions;citation_pages=334-43;citation_volume=148;citation_year=2015" /> <meta name="citation_reference" content="citation_journal_title=Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association;citation_journal_abbrev=Clin Gastroenterol Hepatol;citation_author=E. Saritas Yuksel;citation_author=T. Higginbotham;citation_author=JC. Slaughter;citation_title=Use of direct, endoscopic-guided measurements of mucosal impedance in diagnosis of gastroesophageal reflux disease.;citation_pages=1110-1116;citation_volume=10;citation_year=2012;citation_issue=10;citation_pmid=22642956;citation_doi=10.1016/j.cgh.2012.05.018" /> <meta name="citation_reference" content="citation_journal_title=Surgical endoscopy;citation_journal_abbrev=Surg Endosc;citation_author=WW. Chan;citation_author=LR. Haroian;citation_author=CP. Gyawali;citation_title=Value of preoperative esophageal function studies before laparoscopic antireflux surgery.;citation_pages=2943-2949;citation_volume=25;citation_year=2011;citation_issue=9;citation_pmid=21424193" /> <meta name="citation_reference" content="citation_journal_title=Neurogastroenterol Motil;citation_title=Fragmented and failed swallows on esophageal high-resolution manometry associate with abnormal reflux burden better than weak swallows;citation_volume=32;citation_year=2020" /> <meta name="citation_reference" content="citation_journal_title=J Clin Gastroenterol;citation_author=A. Rengarajan;citation_author=CP. Gyawali;citation_title=High-resolution manometry can characterize esophagogastric junction morphology and predict esophageal reflux burden;citation_pages=22-7;citation_volume=54;citation_year=2020" /> <meta name="citation_reference" content="citation_journal_title=Neurogastroenterol Motil;citation_title=In ineffective esophageal motility, failed swallows are more functionally relevant than weak swallows;citation_volume=30;citation_year=2018" /> <meta name="citation_fulltext_world_readable" content="" /> <meta name="twitter:title" content="Updates to the modern diagnosis of GERD: Lyon consensus 2.0" /> <meta name="twitter:card" content="summary_large_image" /> <meta name="twitter:image" content="https://gut.bmj.com/sites/default/files/highwire/gutjnl/73/2.cover-source.jpg" /> <meta name="twitter:description" content="The Lyon Consensus provides conclusive criteria for and against the diagnosis of gastro-oesophageal reflux disease (GERD), and adjunctive metrics that consolidate or refute GERD diagnosis when primary criteria are borderline or inconclusive. An international core and working group was assembled to evaluate research since publication of the original Lyon Consensus, and to vote on statements collaboratively developed to update criteria. The Lyon Consensus 2.0 provides a modern definition of actionable GERD, where evidence from oesophageal testing supports revising, escalating or personalising GERD management for the symptomatic patient. Symptoms that have a high versus low likelihood of relationship to reflux episodes are described. Unproven versus proven GERD define diagnostic strategies and testing options. Patients with no prior GERD evidence (unproven GERD) are studied using prolonged wireless pH monitoring or catheter-based pH or pH-monitoring off antisecretory medication, while patients with conclusive GERD evidence (proven GERD) and persisting symptoms are evaluated using pH-impedance monitoring while on optimised antisecretory therapy. The major changes from the original Lyon Consensus criteria include establishment of Los Angeles grade B oesophagitis as conclusive GERD evidence, description of metrics and thresholds to be used with prolonged wireless pH monitoring, and inclusion of parameters useful in diagnosis of refractory GERD when testing is performed on antisecretory therapy in proven GERD. Criteria that have not performed well in the diagnosis of actionable GERD have been retired. Personalisation of investigation and management to each patient鈥檚 unique presentation will optimise GERD diagnosis and management." /> <meta name="og-title" property="og:title" content="Updates to the modern diagnosis of GERD: Lyon consensus 2.0" /> <meta name="og-url" property="og:url" content="https://gut.bmj.com/content/73/2/361" /> <meta name="og-site-name" property="og:site_name" content="Gut" /> <meta name="og-description" property="og:description" content="The Lyon Consensus provides conclusive criteria for and against the diagnosis of gastro-oesophageal reflux disease (GERD), and adjunctive metrics that consolidate or refute GERD diagnosis when primary criteria are borderline or inconclusive. An international core and working group was assembled to evaluate research since publication of the original Lyon Consensus, and to vote on statements collaboratively developed to update criteria. The Lyon Consensus 2.0 provides a modern definition of actionable GERD, where evidence from oesophageal testing supports revising, escalating or personalising GERD management for the symptomatic patient. Symptoms that have a high versus low likelihood of relationship to reflux episodes are described. Unproven versus proven GERD define diagnostic strategies and testing options. Patients with no prior GERD evidence (unproven GERD) are studied using prolonged wireless pH monitoring or catheter-based pH or pH-monitoring off antisecretory medication, while patients with conclusive GERD evidence (proven GERD) and persisting symptoms are evaluated using pH-impedance monitoring while on optimised antisecretory therapy. The major changes from the original Lyon Consensus criteria include establishment of Los Angeles grade B oesophagitis as conclusive GERD evidence, description of metrics and thresholds to be used with prolonged wireless pH monitoring, and inclusion of parameters useful in diagnosis of refractory GERD when testing is performed on antisecretory therapy in proven GERD. Criteria that have not performed well in the diagnosis of actionable GERD have been retired. Personalisation of investigation and management to each patient鈥檚 unique presentation will optimise GERD diagnosis and management." /> <meta name="og-type" property="og:type" content="article" /> <meta name="og-image" property="og:image" content="https://gut.bmj.com/sites/default/files/highwire/gutjnl/73/2.cover-source.jpg" /> <title>Updates to the modern diagnosis of GERD: Lyon consensus 2.0 | Gut</title> <link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__ECzVYLXH-tIICkX4eZ7wvkB0t9i2YYOrzMpnyX0xM40__BkUQ0yKymMbiRZNLbV7c1Pg0jmMBE1pa-Dap8Tr0rIU__RBpwsggTa-66iCd391Lg7-ZmaIvHPOUAGYyVtdCScb8.css" media="all" />  <script src="https://cookie-cdn.cookiepro.com/scripttemplates/otSDKStub.js" type="text/javascript" charset="UTF-8" data-domain-script="565e50dd-f6e9-46d6-91cd-5c40a270264f"></script> <script type="text/javascript"> function OnetrustAdsConsent(){ if(googletag.apiReady){ //console.log("GoogleTag API ready") googletag.pubads().disableInitialLoad(); if(OptanonActiveGroups.match(/,4,/)){ googletag.pubads().setRequestNonPersonalizedAds(0); //googletag.pubads().refresh(); } else{ googletag.pubads().setRequestNonPersonalizedAds(1); googletag.pubads().refresh(); } } else{ OnetrustAdsConsent(); } } function OptanonWrapper() { OnetrustAdsConsent(); } </script>  <script type="text/javascript" src="/sites/default/files/advagg_js/js__DdxPgqGimsdUot2QWNz_pGsHzqNGpx6RMCWHpL8YWkg__c6zfK6oHHbLpTal5PdQxeQI3xGoCM8IXWtEHwIZr560__RBpwsggTa-66iCd391Lg7-ZmaIvHPOUAGYyVtdCScb8.js"></script> <script type="text/javascript" src="https://securepubads.g.doubleclick.net/tag/js/gpt.js"></script> <script type="text/javascript" src="/sites/default/files/advagg_js/js__vvNVlYWIx5aBJ0XQ4dNLRE2-6M9BGvClAi9607MmG4Y__5Lit7ODTTw7yTJlVTzglGiDFFtPDxIvyMxrzss64TbI__RBpwsggTa-66iCd391Lg7-ZmaIvHPOUAGYyVtdCScb8.js"></script> <script type="text/javascript" defer="defer" async="async" src="//cdn.foxycart.com/bmjpg.ecommerce.highwire.org/loader.js"></script> <script type="text/javascript" async="async" src="https://scholar.google.com/scholar_js/casa.js"></script> <script type="text/javascript"> <![CDATA[//><!]]> </script> <script type="text/javascript"> <![CDATA[//><!]]> </script> <script type="text/javascript"> <![CDATA[//><!]]> </script> <script type="text/javascript"> <![CDATA[//><!]]> </script> <script type="text/javascript"> <![CDATA[//><!]]> </script> <script type="text/javascript"> <![CDATA[//><!]]> </script> <script type="text/javascript"> <![CDATA[//><!]]> </script> <script type="text/javascript"> <![CDATA[//><!]]> </script> <script type="text/javascript"> <![CDATA[//><!]]> </script>   <script> let cookies = parseCookies(); let bmj_uuid = cookies.bmj_uuid; let bmj_ppid = cookies.bmj_ppid; window.dataLayer = window.dataLayer || []; const anonMailId = 'e3b0c44298fc1c149afbf4c8996fb92427ae41e4649b934ca495991b7852b855'; function checkUserLoginStatus(dataLayer) { const userMail = dataLayer.find((item) => item.user)?.user?.mail; if (!userMail) { return false; } return userMail !== anonMailId; } let nonAnonMailId = ((dataLayer.find(item => item.user)?.user)?.mail) === anonMailId ? null : (dataLayer.find(item => item.user)?.user)?.mail; let userId = ((dataLayer.find(item => item.user)?.user)?.['data-ics']) ?? ((dataLayer.find(item => item.user)?.user)?.mail && nonAnonMailId) ?? bmj_ppid ?? bmj_uuid; document.cookie = 'bmj_ppid=' + userId + '; domain=.bmj.com; path=/; max-age=31622400; SameSite=None; Secure'; googletag.cmd.push(function() { googletag.pubads().setPublisherProvidedId(userId); googletag.pubads().setTargeting("islogged", checkUserLoginStatus(dataLayer) ? "true" : "false"); googletag.enableServices(); }); window.dataLayer.push({ 'bmj_uuid': bmj_uuid }); </script> </head> <body class="html not-front not-logged-in no-sidebars page-node page-node- page-node-258738 node-type-highwire-article">  <noscript><iframe src="//www.googletagmanager.com/ns.html?id=GTM-KMTW8J" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript> <script type="text/javascript">(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-KMTW8J');</script>  <div id="skip-link"> <a href="#main-content" class="element-invisible element-focusable">Skip to main content</a> </div> <div class="page" id="page"> <section class="container-fluid content-header"> <header role="banner" class="section section-header row"> <div class="zone zone-superheader"> <div class="region region-superheader"> <div class="region-inner region-superheader-inner"> <div class="region region-superheader"> <div id="block-panels-mini-jnl-template-bmjj-uid-strng" class="block block-panels-mini" class="block block-panels-mini"> <div class="content"> <div class="panel-display panel-1col clearfix" id="mini-panel-jnl_template_bmjj_uid_strng"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-dfp-pane" > <div class="pane-content"> <div id="dfp-ad-top-wrapper" class="dfp-tag-wrapper"> <div id="dfp-ad-top" class="dfp-tag-wrapper"> <script type="text/javascript"> googletag.cmd.push(function() { googletag.display("dfp-ad-top"); }); </script> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="site-info mobile-hidden"> </div> <div class="zone zone-header row mobile-hidden"> <div class="region region-header"> <div class="region-inner region-header-inner"> </div> </div> </div> </header>  <section class="row visible-sm visible-md visible-lg header header-platform mobile-hidden"> <div class="col-narrow-3 col-normal-3 col-large-3 logo-bmj"> <div class="l-inline"> <p class="logo-bmj-journals"><a href="http://journals.bmj.com/" title="BMJ Journals"><img src="/sites/default/themes/bmjj/img/logos/logo-bmj-journals.svg" title="BMJ Journals" alt="BMJ Journals"/></a></p> </div> </div> <div class="col-narrow-9 col-normal-9 col-large-9 no-right-padding"> <div class="region region-top"> <div class="region-inner"> <div class="region region-platmenu"> <div id="block-menu-menu-platform-menu" class="block block-menu" class="block block-menu"> <div class="content"> <ul class="menu"><li class="first leaf"><a href="/subscribe" data-hide-link-title="0" class="header-subscribe-link" data-icon-position="">Subscribe</a></li> <li class="leaf"><a href="/" id="menu-login" class="drop-menu link-icon-right link-icon"><span class="title">Log In</span> <span class="icon icon-arrow-down"></span></a> <a href="# " class="menu-attach-block-drop-link external expand-on-click" data-block-id="panels_mini|challenge_opportunity_pane_dropdown" id="<front>-drop-link-728" data-icon-position="" data-hide-link-title="0">More</a><div class="menu-attach-block-wrapper"> <div id="block-panels-mini-challenge-opportunity-pane-dropdown" class="block block-panels-mini article-login bmjj-login" class="block block-panels-mini"> <div class="content"> <div class="panel-display panel-1col clearfix" id="mini-panel-challenge_opportunity_pane_dropdown-1"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-bmjj-society-logins society-logins" > <div class="pane-content"> <span class="ui-button ui-state-default ui-dialog-titlebar-close" title="close"></span><div class="shib-login-link"><a href="/login/shibboleth?subcode=bmjjournals&env=prod&uri=https%3A//gut.bmj.com/accallback/content%25252F73%25252F2%25252F361" class="button society-login-link" data-icon-position="" data-hide-link-title="0">Log in via Institution</a></div><div class="openathens-login-link"><a href="https://openathens-sp.highwire.org/session/init?entityID=https%3A//idp.eduserv.org.uk/openathens&hw-shib-return-uri=https%3A//gut.bmj.com/accallback/content%25252F73%25252F2%25252F361&subcode=bmjjournals" class="button society-login-link" data-icon-position="" data-hide-link-title="0">Log in via OpenAthens</a></div><a href="https://www.bsg.org.uk/login.html" class="button society-login-link" data-icon-position="" data-hide-link-title="0">Log in via BSG</a> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-opportunity-challenge" > <div class="pane-content"> <div class='opportunity-challenge-login'><h3>Log in using your username and password</h3><div class="drupal-login compact"><form action="/content/73/2/361.citation-tools" method="post" id="highwire-user-login--3" accept-charset="UTF-8"><div><div id="edit-customtext--3" class="form-item form-item-label-before form-type-item"> <span class="customtext">For personal accounts OR managers of institutional accounts</span> </div> <div class="form-item form-item-label-invisible form-type-textfield form-item-name"> <label class="element-invisible" for="edit-name--3">Username <span class="form-required" title="This field is required.">*</span></label> <input placeholder="Username" type="text" id="edit-name--3" name="name" value="" size="30" maxlength="60" class="form-text required" /> </div> <div class="form-item form-item-label-invisible form-type-password form-item-pass"> <label class="element-invisible" for="edit-pass--3">Password <span class="form-required" title="This field is required.">*</span></label> <input placeholder="Password" type="password" id="edit-pass--3" name="pass" size="30" maxlength="128" class="form-text required" /> </div> <input type="hidden" name="form_build_id" value="form-zk9N13LY9QPyHbOY95uPz6Dy7XKbUMrwzXy-RkyipLQ" /> <input type="hidden" name="form_id" value="highwire_user_login" /> <div class="bmjj-reset-password"><a href="/user/password" class="" data-icon-position="" data-hide-link-title="0">Forgot your log in details?</a><a href="/user/register?destination=node/258738%3Fpanels_ajax_tab_tab%3Djnl_template_bmjj_cite_tool%26panels_ajax_tab_trigger%3Dcitation-tools" class="" data-icon-position="" data-hide-link-title="0">Register a new account?</a></div><div class="form-actions form-wrapper" id="edit-actions--3"><input type="submit" id="edit-submit--3" name="op" value="Log in" class="form-submit" /></div><div class="reset-password"><a href="/user/password" class="" data-icon-position="" data-hide-link-title="0">Forgot</a> your user name or password?</div></div></form></div></div> </div> </div> </div> </div> </div> </div> </div> </div> </li> <li class="leaf"><a href="/cart" class="link-icon-right link-icon"><span class="title">Basket</span> <span class="icon icon-basket"></span></a></li> <li class="last leaf"><a href="/search" id="menu-search" class="drop-menu link-icon-right link-icon"><span class="title">Search</span> <span class="icon icon-search"></span></a> <a href="# " class="menu-attach-block-drop-link external expand-on-click" data-block-id="panels_mini|jnl_template_bmjj_search_box" id="search-drop-link-729" data-icon-position="" data-hide-link-title="0">More</a><div class="menu-attach-block-wrapper"> <div id="block-panels-mini-jnl-template-bmjj-search-box" class="block block-panels-mini" class="block block-panels-mini"> <div class="content"> <div class="panel-display one-layout " id="mini-panel-jnl_template_bmjj_search_box-1"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-seach-quicksearch block-search pull-left" > <div class="pane-content"> <form class="highwire-quicksearch button-style-mini button-style-mini" action="/content/73/2/361.citation-tools" method="post" id="highwire-search-quicksearch-form-1" accept-charset="UTF-8"><div><div class="form-item form-item-label-invisible form-type-textfield form-item-keywords"> <label class="element-invisible" for="search_rightsidebar_keywords_538705136">Search for this keyword </label> <input placeholder="search" type="text" id="search_rightsidebar_keywords_538705136" name="keywords" value="" size="60" maxlength="128" class="form-text" /> </div> <input data-icon-only="1" data-font-icon="icon-search" data-icon-position="after" type="submit" id="search_rightsidebar_submit_991680705" name="op" value="Search" class="form-submit" /><input type="hidden" name="form_build_id" value="form-SM_vFEJP2GSh9WZyslx_tzwQn47BcvBKn2JxBuC5rXg" /> <input type="hidden" name="form_id" value="highwire_search_quicksearch_form_1" /> </div></form> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-custom pane-4 pull-right advanced-search-link" > <div class="pane-content"> <a href="/search">Advanced search</a> </div> </div> </div> </div> </div> </div> </div> </div> </li> </ul> </div> </div> </div> </div> </div> </div> </section> <div class="row header header-journal"> <div class="col-mobile-7 col-narrow-2 col-normal-4 logo-journal"> <a href="/"><img src="https://resources.bmj.com/repository/journals-network-project/images/journal-logos/logo-gut.svg" alt="Gut" id="logo-img"></a> </div> <div class="col-mobile-5 col-narrow-10 col-normal-8 no-right-padding nav-journal"> <div class="region region-journmenu"> <div id="block-system-main-menu" class="block block-system mobile-hidden block-menu" class="block block-system mobile-hidden block-menu"> <div class="content"> <ul class="menu"><li class="first leaf"><a href="http://gut.bmj.com/pages/education-in-gastroenterology" class="" data-icon-position="" data-hide-link-title="0">CME/CPD</a></li> <li class="leaf"><a href="/content/early/recent" class="" data-icon-position="" data-hide-link-title="0">Latest content</a></li> <li class="leaf"><a href="/content/current" class="" data-icon-position="" data-hide-link-title="0">Current issue</a></li> <li class="leaf"><a href="/content/by/year" class="" data-icon-position="" data-hide-link-title="0">Archive</a></li> <li class="leaf"><a href="http://gut.bmj.com/pages/authors/" class="" data-icon-position="" data-hide-link-title="0">Authors</a></li> <li class="last leaf"><a href="http://gut.bmj.com/pages/about/" class="" data-icon-position="" data-hide-link-title="0">About</a></li> </ul> </div> </div> <div id="block-panels-mini-mobile-slide-out-menu" class="block block-panels-mini mobile-only" class="block block-panels-mini mobile-only"> <div class="content"> <div class="panel-display panel-1col clearfix" id="mini-panel-mobile_slide_out_menu"> <div class="panel-panel panel-col"> <div><div id="" class="highwire-responsive-toggle-group"><div class="panel-pane pane-panels-mini pane-jnl-template-bmjj-search-box" > <h2 class="pane-title"><span class="icon-search"></span></h2> <div class="pane-content"> <div class="panel-display one-layout " id="mini-panel-jnl_template_bmjj_search_box"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-seach-quicksearch block-search pull-left" > <div class="pane-content"> <form class="highwire-quicksearch button-style-mini button-style-mini" action="/content/73/2/361.citation-tools" method="post" id="highwire-search-quicksearch-form-0" accept-charset="UTF-8"><div><div class="form-item form-item-label-invisible form-type-textfield form-item-keywords"> <label class="element-invisible" for="search_rightsidebar_keywords_1176217125">Search for this keyword </label> <input placeholder="search" type="text" id="search_rightsidebar_keywords_1176217125" name="keywords" value="" size="60" maxlength="128" class="form-text" /> </div> <input data-icon-only="1" data-font-icon="icon-search" data-icon-position="after" type="submit" id="search_rightsidebar_submit_1042829302" name="op" value="Search" class="form-submit" /><input type="hidden" name="form_build_id" value="form-4OgQWXR9PHzcIb_ZC4xZcBLgmrXSb-yJmjtK1koCfBo" /> <input type="hidden" name="form_id" value="highwire_search_quicksearch_form_0" /> </div></form> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-custom pane-3 pull-right advanced-search-link" > <div class="pane-content"> <a href="/search">Advanced search</a> </div> </div> </div> </div> </div> </div> </div> <div class="panel-pane pane-block pane-menu-menu-mobile-slideout-menu pane-menu" > <h2 class="pane-title"><span class="icon-menu"></span></h2> <div class="pane-content"> <ul class="menu"><li class="first leaf"><a href="/" class="menu-close link-icon-only link-icon"><span class="icon icon-close"></span> <span class="title element-invisible">Close</span></a> <a href="# " class="menu-attach-block-drop-link external expand-on-click" data-block-id="panels_mini|mobile_slide_out_autobot_menu" id="<front>-drop-link-781" data-icon-position="" data-hide-link-title="0">More</a><div class="menu-attach-block-wrapper"> <div id="block-panels-mini-mobile-slide-out-autobot-menu" class="block block-panels-mini" class="block block-panels-mini"> <div class="content"> <div class="panel-display one-layout " id="mini-panel-mobile_slide_out_autobot_menu"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-menu-tree pane-main-menu" > <h2 class="pane-title">Main menu</h2> <div class="pane-content"> <div class="menu-block-wrapper menu-block-ctools-main-menu-1 menu-name-main-menu parent-mlid-main-menu:0 menu-level-1"> <ul class="menu"><li class="first leaf menu-mlid-15072"><a href="http://gut.bmj.com/pages/education-in-gastroenterology" class="" data-icon-position="" data-hide-link-title="0">CME/CPD</a></li> <li class="leaf menu-mlid-15073"><a href="/content/early/recent" class="" data-icon-position="" data-hide-link-title="0">Latest content</a></li> <li class="leaf menu-mlid-15074"><a href="/content/current" class="" data-icon-position="" data-hide-link-title="0">Current issue</a></li> <li class="leaf menu-mlid-15075"><a href="/content/by/year" class="" data-icon-position="" data-hide-link-title="0">Archive</a></li> <li class="leaf menu-mlid-15076"><a href="http://gut.bmj.com/pages/authors/" class="" data-icon-position="" data-hide-link-title="0">Authors</a></li> <li class="last leaf menu-mlid-15077"><a href="http://gut.bmj.com/pages/about/" class="" data-icon-position="" data-hide-link-title="0">About</a></li> </ul></div> </div> </div> </div> </div> </div> </div> </div> </div> </li> <li class="leaf"><a href="/subscribe" data-hide-link-title="0" class="callout-link" data-icon-position="">Subscribe</a></li> <li class="leaf"><a href="/" class="mobile-drop-down callout-link link-icon-right link-icon"><span class="title">Log in</span> <span class="icon icon-plus"></span></a> <a href="# " class="menu-attach-block-drop-link external expand-on-click" data-block-id="panels_mini|jnl_template_bmjj_login" id="<front>-drop-link-780" data-icon-position="" data-hide-link-title="0">More</a><div class="menu-attach-block-wrapper"> <div id="block-panels-mini-jnl-template-bmjj-login" class="block block-panels-mini" class="block block-panels-mini"> <div class="content"> <div class="panel-display panel-1col clearfix" id="mini-panel-jnl_template_bmjj_login"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-bmjj-society-logins society-logins opportunity-challenge-login" > <div class="pane-content"> <span class="ui-button ui-state-default ui-dialog-titlebar-close" title="close"></span><div class="shib-login-link"><a href="/login/shibboleth?subcode=bmjjournals&env=prod&uri=https%3A//gut.bmj.com/accallback/content%25252F73%25252F2%25252F361" class="button society-login-link" data-icon-position="" data-hide-link-title="0">Log in via Institution</a></div><div class="openathens-login-link"><a href="https://openathens-sp.highwire.org/session/init?entityID=https%3A//idp.eduserv.org.uk/openathens&hw-shib-return-uri=https%3A//gut.bmj.com/accallback/content%25252F73%25252F2%25252F361&subcode=bmjjournals" class="button society-login-link" data-icon-position="" data-hide-link-title="0">Log in via OpenAthens</a></div><a href="https://www.bsg.org.uk/login.html" class="button society-login-link" data-icon-position="" data-hide-link-title="0">Log in via BSG</a> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-opportunity-challenge" > <div class="pane-content"> <div class='opportunity-challenge-login'><h3>Log in using your username and password</h3><div class="drupal-login compact"><form action="/content/73/2/361.citation-tools" method="post" id="highwire-user-login--2" accept-charset="UTF-8"><div><div id="edit-customtext--2" class="form-item form-item-label-before form-type-item"> <span class="customtext">For personal accounts OR managers of institutional accounts</span> </div> <div class="form-item form-item-label-invisible form-type-textfield form-item-name"> <label class="element-invisible" for="edit-name--2">Username <span class="form-required" title="This field is required.">*</span></label> <input placeholder="Username" type="text" id="edit-name--2" name="name" value="" size="30" maxlength="60" class="form-text required" /> </div> <div class="form-item form-item-label-invisible form-type-password form-item-pass"> <label class="element-invisible" for="edit-pass--2">Password <span class="form-required" title="This field is required.">*</span></label> <input placeholder="Password" type="password" id="edit-pass--2" name="pass" size="30" maxlength="128" class="form-text required" /> </div> <input type="hidden" name="form_build_id" value="form-LE8XBHYzwWetNcMizCmQPqGCX5r26d8XjU3MYAnDQ3c" /> <input type="hidden" name="form_id" value="highwire_user_login" /> <div class="bmjj-reset-password"><a href="/user/password" class="" data-icon-position="" data-hide-link-title="0">Forgot your log in details?</a><a href="/user/register?destination=node/258738%3Fpanels_ajax_tab_tab%3Djnl_template_bmjj_cite_tool%26panels_ajax_tab_trigger%3Dcitation-tools" class="" data-icon-position="" data-hide-link-title="0">Register a new account?</a></div><div class="form-actions form-wrapper" id="edit-actions--2"><input type="submit" id="edit-submit--2" name="op" value="Log in" class="form-submit" /></div><div class="reset-password"><a href="/user/password" class="" data-icon-position="" data-hide-link-title="0">Forgot</a> your user name or password?</div></div></form></div></div> </div> </div> </div> </div> </div> </div> </div> </div> </li> <li class="last leaf"><a href="http://journals.bmj.com/" data-hide-link-title="0" class="bmj-link" data-icon-position="">BMJ Journals</a></li> </ul> </div> </div> </div></div> </div> </div> </div> </div> </div> </div> </div> </section> <section role="main" class="section section-content container-fluid"> <div class="crumb-navigation"> <div class="row"> <div class="col-mobile-12 col-narrow-9 col-normal-9 col-wide-10 breadcrumbs"> <h2 class="element-invisible">You are here</h2><div class="item-list"><ul class="breadcrumb"><li class="first"><a href="/" class="" data-icon-position="" data-hide-link-title="0">Home</a></li> <li><a href="/content/by/year" class="" data-icon-position="" data-hide-link-title="0">Archive</a></li> <li><a href="/content/73/2" class="" data-icon-position="" data-hide-link-title="0">Volume 73, Issue 2 </a></li> <li class="last"><span class="active">Updates to the modern diagnosis of GERD: Lyon consensus 2.0</span></li> </ul></div> </div> <div class="mobile-hidden col-narrow-3 col-normal-3 col-wide-2 email-alerts"> <span> <a href="https://myaccount.bmj.com/myaccount/signup.html?regService=etoc-alerts&corpusCode=gutjnl&fwdUrl=https://gut.bmj.com/" class="email-alerts-label"><i class="icon icon-article-alerts"></i>Email alerts</a> </span> </div> </div> </div> <div class="container"> <div class="zone zone-content row"> <div class="region region-content col-narrow-12"> <div class="region-inner region-content-inner"> <a id="main-content"></a> <div class="region region-content"> <div id="block-system-main" class="block block-system" class="block block-system"> <div class="content"> <div class="panel-display two-layout " > <div class="panel-row-wrapper panel-row-first row"> <div class="top-wrapper col-narrow-12"> <div class="panel-panel panel-region-top"> <div class="inside"><div class="panel-pane pane-panels-mini pane-article-tabset-mobile mobile-only" id="mobile-article-tab-container"> <div class="pane-content"> <div class="panel-display two-layout " id="mini-panel-article_tabset_mobile_"> <div class="panel-row-wrapper row"> <div class="left-wrapper col-mobile-6"> <div class="panel-panel panel-region-left"> <div class="inside"><div class="panel-pane pane-bmjj-mob-tab-title" id="mobile-tab-title"> <div class="pane-content"> <p><span class="icon-citation-tools"></span>Citation Tools</p> </div> </div> </div> </div> </div> <div class="right-wrapper col-mobile-6"> <div class="panel-panel panel-region-right"> <div class="inside"><div class="panel-pane pane-bmjj-mobile-article-menu" > <div class="pane-content"> <a href="#block-system-main" class="mobile-article-tab" data-icon-position="" data-hide-link-title="0">Article menu <span class="icon-plus icon-toggle"></span></a><div class="mobile-art-drop-down"></div> </div> </div> </div> </div> </div> </div>  </div> </div> </div> </div> </div> </div> </div>  <div class="panel-row-wrapper row relative" id="article-top"> <div class="left-wrapper col-narrow-2 col-normal-1 col-wide-1 tab-pane"> <div class="panel-panel panel-region-left"> <div class="inside"><div class="panel-pane pane-highwire-panel-tabs pane-panels-ajax-tab-tabs nav nav-tabs nav-stacked articleToolbar mobile-hidden" id="nav-tabs"> <div class="pane-content"> <div class="item-list"><ul class="tabs inline panels-ajax-tab"><li class=" first"><a href="/content/73/2/361" class="panels-ajax-tab-tab" data-panel-name="jnl_template_bmjj_tab_art" data-target-id="highwire_article_tabs" data-entity-context="node:258738" data-trigger="" data-url-enabled="1"><span class="icon-article-text"></span>Article <br/>Text</a><a href="/panels_ajax_tab/jnl_template_bmjj_tab_art/node:258738/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li> <li class=""><a href="/content/73/2/361.info" class="panels-ajax-tab-tab" data-panel-name="jnl_template_bmjj_art_info" data-target-id="highwire_article_tabs" data-entity-context="node:258738" data-trigger="info" data-url-enabled="1"><span class="icon-article-info"></span>Article <br/>info</a><a href="/panels_ajax_tab/jnl_template_bmjj_art_info/node:258738/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li> <li class="active"><a href="/content/73/2/361.citation-tools" class="panels-ajax-tab-tab" data-panel-name="jnl_template_bmjj_cite_tool" data-target-id="highwire_article_tabs" data-entity-context="node:258738" data-trigger="citation-tools" data-url-enabled="1"><span class="icon-citation-tools"></span>Citation <br/>Tools</a><a href="/panels_ajax_tab/jnl_template_bmjj_cite_tool/node:258738/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li> <li class=""><a href="/content/73/2/361.share" class="panels-ajax-tab-tab" data-panel-name="jnl_template_bmjj_share" data-target-id="highwire_article_tabs" data-entity-context="node:258738" data-trigger="share" data-url-enabled="1"><span class="icon-share"></span>Share</a><a href="/panels_ajax_tab/jnl_template_bmjj_share/node:258738/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li> <li class=""><a href="/content/73/2/361.responses" class="panels-ajax-tab-tab" data-panel-name="jnl_template_bmjj_tab_elets" data-target-id="highwire_article_tabs" data-entity-context="node:258738" data-trigger="responses" data-url-enabled="1"><span class="icon-responses"></span>Rapid Responses</a><a href="/panels_ajax_tab/jnl_template_bmjj_tab_elets/node:258738/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li> <li class=""><a href="/content/73/2/361.altmetrics" class="panels-ajax-tab-tab" data-panel-name="jnl_template_bmjj_tab_altmetrics" data-target-id="highwire_article_tabs" data-entity-context="node:258738" data-trigger="altmetrics" data-url-enabled="1"><span class="icon-article-stats"></span>Article <br/>metrics</a><a href="/panels_ajax_tab/jnl_template_bmjj_tab_altmetrics/node:258738/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li> <li class=" last"><a href="/content/73/2/361.alerts" class="panels-ajax-tab-tab" data-panel-name="jnl_template_bmjj_art_alert" data-target-id="highwire_article_tabs" data-entity-context="node:258738" data-trigger="alerts" data-url-enabled="1"><span class="icon-article-alerts"></span>Alerts</a><a href="/panels_ajax_tab/jnl_template_bmjj_art_alert/node:258738/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li> </ul></div> </div> </div> </div> </div> </div> <div class="right-wrapper col-narrow-9 col-normal-10 col-wide-10 article-pane panel-region-main"> <div class="panel-panel panel-region-right"> <div class="inside"><div class="panel-pane pane-panels-mini pane-jnl-template-bmjj-art-pdf col-mobile-2 col-narrow-2 col-normal-1 pull-right pane-article-pdf" > <div class="pane-content"> <div class="panel-display one-layout " id="mini-panel-jnl_template_bmjj_art_pdf"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-custom pane-1 article-pdf-link" > <div class="pane-content"> <p><a class="article-pdf-download" href="/content/gutjnl/73/2/361.full.pdf" target="new"><img alt="Download PDF" src="/sites/default/themes/bmjj/img/icon-pdf.png" /><strong>PDF</strong></a></p> </div> </div> </div> </div> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-entity-field pane-node-field-highwire-article-cat article-category col-narrow-9 col-normal-10" > <div class="pane-content"> <div class="field field-name-field-highwire-article-cat field-type-text field-label-hidden"><div class="field-items"><div class="field-item even">Recent advances in clinical practice</div></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-article-citation col-mobile-10 col-narrow-10 col-normal-11 article-title" > <div class="pane-content"> <div class="highwire-article-citation highwire-citation-type-highwire-article node258738" data-node-nid="258738" id="node-258738--2506828312" data-pisa="gutjnl;73/2/361" data-pisa-master="gutjnl;gutjnl-2023-330616" data-apath="/gutjnl/73/2/361.atom"><cite class="highwire-cite highwire-cite-highwire-article highwire-citation-bmjj-title clearfix"> <div class="highwire-cite-title">Updates to the modern diagnosis of GERD: Lyon consensus 2.0</div> <span class="highwire-cite-access"><span class="highwire-citation-access"><svg class="icon icon-open-access bmjj-open-access bmjj-access-tag"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon-openaccess"></use><svg></svg></svg></span></span> </cite> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-panel-tabs-container col-narrow-12 clear" > <div class="pane-content"> <div data-panels-ajax-tab-preloaded="jnl_template_bmjj_cite_tool" id="panels-ajax-tab-container-highwire_article_tabs" class="panels-ajax-tab-container"><div class="panels-ajax-tab-loading" style ="display:none"><img class="loading" src="https://gut.bmj.com/sites/all/modules/contrib/panels_ajax_tab/images/loading.gif" alt="Loading" title="Loading" /></div><div class="panels-ajax-tab-wrap-jnl_template_bmjj_cite_tool"><div class="panel-display panel-1col clearfix" > <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-citation-export" > <h2 class="pane-title">Download to a citation manager</h2> <div class="pane-content"> <div class="highwire-citation-export"> <div class="highwire-citation-formats"> <p class="links-title">Download the citation for this article by clicking on one of the following citation managers:</p> <div class="highwire-citation-formats-links col-narrow-10 col-narrow-push-1"> <span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.spage=361&rft.epage=371&rft.atitle=Updates%20to%20the%20modern%20diagnosis%20of%20GERD%3A%20Lyon%20consensus%202.0&rft.volume=73&rft.issue=2&rft.date=2024-02-01%2000%3A00%3A00&rft.stitle&rft.jtitle=Gut&rft.au=Gyawali%2C+C+Prakash&rft.au=Yadlapati%2C+Rena&rft.au=Fass%2C+Ronnie&rft.au=Katzka%2C+David&rft.au=Pandolfino%2C+John&rft.au=Savarino%2C+Edoardo&rft.au=Sifrim%2C+Daniel&rft.au=Spechler%2C+Stuart&rft.au=Zerbib%2C+Frank&rft.au=Fox%2C+Mark+R&rft.au=Bhatia%2C+Shobna&rft.au=de+Bortoli%2C+Nicola&rft.au=Cho%2C+Yu+Kyung&rft.au=Cisternas%2C+Daniel&rft.au=Chen%2C+Chien-Lin&rft.au=Cock%2C+Charles&rft.au=Hani%2C+Albis&rft.au=Remes+Troche%2C+Jose+Maria&rft.au=Xiao%2C+Yinglian&rft.au=Vaezi%2C+Michael+F&rft.au=Roman%2C+Sabine"></span><ul class="hw-citation-links inline"><li class="bibtext first"><a href="/highwire/citation/258738/bibtext" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">BibTeX</a></li> <li class="bookends"><a href="/highwire/citation/258738/bookends" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">Bookends</a></li> <li class="easybib"><a href="/highwire/citation/258738/easybib" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">EasyBib</a></li> <li class="endnote-tagged"><a href="/highwire/citation/258738/endnote-tagged" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">EndNote (tagged)</a></li> <li class="endnote-8-xml"><a href="/highwire/citation/258738/endnote-8-xml" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">EndNote 8 (xml)</a></li> <li class="medlars"><a href="/highwire/citation/258738/medlars" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">Medlars</a></li> <li class="mendeley"><a href="/highwire/citation/258738/mendeley" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">Mendeley</a></li> <li class="papers"><a href="/highwire/citation/258738/papers" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">Papers</a></li> <li class="refworks-tagged"><a href="/highwire/citation/258738/refworks-tagged" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">RefWorks Tagged</a></li> <li class="reference-manager"><a href="/highwire/citation/258738/reference-manager" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">Ref Manager</a></li> <li class="ris"><a href="/highwire/citation/258738/ris" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">RIS</a></li> <li class="zotero last"><a href="/highwire/citation/258738/zotero" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">Zotero</a></li> </ul> </div> </div> <div class="highwire-citation-info col-narrow-12"> <dl> <dt>Cite this article as:</dt> <dd><div class="highwire-article-citation highwire-citation-type-highwire-article cite-tool-node258738--3" data-node-nid="258738" id="citation-node-258738--4289553061" data-pisa="gutjnl;73/2/361" data-pisa-master="gutjnl;gutjnl-2023-330616" data-apath="/gutjnl/73/2/361.atom"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-v1-issue clearfix bmjj-article-citation"> <div class="highwire-cite-authors"><span class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-surname">Gyawali</span> CP</span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-surname">Yadlapati</span> R</span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-surname">Fass</span> R</span></span><span class="citation-et">, et al</span></div> <div class="highwire-cite-title">Updates to the modern diagnosis of GERD: Lyon consensus 2.0</div> <div class="highwire-cite-metadata bmjj-citation-metadata"><span class="highwire-cite-metadata-journal highwire-cite-metadata">Gut </span><span class="highwire-cite-metadata-year highwire-cite-metadata">2024;</span><span class="highwire-cite-metadata-volume highwire-cite-metadata">73:</span><span class="highwire-cite-metadata-pages highwire-cite-metadata">361-371. </span></div> </div></div></dd> </dl> </div> </div> </div> </div> </div> </div> </div> </div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-panels-mini pane-jnl-template-bmjj-challenge article-login col-narrow-12 clear hidden" > <h2 class="pane-title">Read the full text or download the PDF:</h2> <div class="pane-content"> <div class="panel-display three-layout " id="mini-panel-jnl_template_bmjj_challenge"> <div class="panel-row-wrapper row"> <div class="left-wrapper col-narrow-12 col-normal-4"> <div class="panel-panel panel-region-left"> <div class="inside"><div class="panel-pane pane-add-to-cart" > <div class="pane-content"> <span class="highwire-foxycart-add-to-cart-ahah highwire-foxycart-add-to-cart-ahah" data-text="Buy this article (%short-price)" data-apath="/gutjnl/73/2/361.atom" data-type="link" data-font-icon="" data-parent-id="258716"></span> </div> </div> </div> </div> </div> <div class="middle-wrapper col-narrow-12 col-normal-4"> <div class="panel-panel panel-region-middle"> <div class="inside"><div class="panel-pane pane-bmjj-article-subscribe-button" > <div class="pane-content"> <a href="/subscribe" class="btn btn-default btn-lg" data-icon-position="" data-hide-link-title="0">Subscribe</a> </div> </div> </div> </div> </div> <div class="right-wrapper col-narrow-12 col-normal-4"> <div class="panel-panel panel-region-right article-login"> <div class="inside"><div class="panel-pane pane-custom pane-2" > <div class="pane-content"> <button type="submit" class="btn btn-default btn-lg" id="sign-in" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false" aria-hidden="true">Log in <svg class="icon icon-white icon-arrow-down"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="/sites/default/themes/bmjj/img/defs.svg#icon-arrow-down"></use></svg></button> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-panels-mini pane-challenge-opportunity-pane-dropdown" > <div class="pane-content"> <div class="panel-display panel-1col clearfix" id="mini-panel-challenge_opportunity_pane_dropdown"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-bmjj-society-logins society-logins" > <div class="pane-content"> <span class="ui-button ui-state-default ui-dialog-titlebar-close" title="close"></span><div class="shib-login-link"><a href="/login/shibboleth?subcode=bmjjournals&env=prod&uri=https%3A//gut.bmj.com/accallback/content%25252F73%25252F2%25252F361" class="button society-login-link" data-icon-position="" data-hide-link-title="0">Log in via Institution</a></div><div class="openathens-login-link"><a href="https://openathens-sp.highwire.org/session/init?entityID=https%3A//idp.eduserv.org.uk/openathens&hw-shib-return-uri=https%3A//gut.bmj.com/accallback/content%25252F73%25252F2%25252F361&subcode=bmjjournals" class="button society-login-link" data-icon-position="" data-hide-link-title="0">Log in via OpenAthens</a></div><a href="https://www.bsg.org.uk/login.html" class="button society-login-link" data-icon-position="" data-hide-link-title="0">Log in via BSG</a> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-opportunity-challenge" > <div class="pane-content"> <div class='opportunity-challenge-login'><h3>Log in using your username and password</h3><div class="drupal-login compact"><form action="/content/73/2/361.citation-tools" method="post" id="highwire-user-login" accept-charset="UTF-8"><div><div id="edit-customtext" class="form-item form-item-label-before form-type-item"> <span class="customtext">For personal accounts OR managers of institutional accounts</span> </div> <div class="form-item form-item-label-invisible form-type-textfield form-item-name"> <label class="element-invisible" for="edit-name">Username <span class="form-required" title="This field is required.">*</span></label> <input placeholder="Username" type="text" id="edit-name" name="name" value="" size="30" maxlength="60" class="form-text required" /> </div> <div class="form-item form-item-label-invisible form-type-password form-item-pass"> <label class="element-invisible" for="edit-pass">Password <span class="form-required" title="This field is required.">*</span></label> <input placeholder="Password" type="password" id="edit-pass" name="pass" size="30" maxlength="128" class="form-text required" /> </div> <input type="hidden" name="form_build_id" value="form-KWzeqFMT9b0J5_igtcdWLIgAiAWIWrYX9kK9ald3t1o" /> <input type="hidden" name="form_id" value="highwire_user_login" /> <div class="bmjj-reset-password"><a href="/user/password" class="" data-icon-position="" data-hide-link-title="0">Forgot your log in details?</a><a href="/user/register?destination=node/258738%3Fpanels_ajax_tab_tab%3Djnl_template_bmjj_cite_tool%26panels_ajax_tab_trigger%3Dcitation-tools" class="" data-icon-position="" data-hide-link-title="0">Register a new account?</a></div><div class="form-actions form-wrapper" id="edit-actions"><input type="submit" id="edit-submit" name="op" value="Log in" class="form-submit" /></div><div class="reset-password"><a href="/user/password" class="" data-icon-position="" data-hide-link-title="0">Forgot</a> your user name or password?</div></div></form></div></div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div>  </div> </div> </div> </div> </div> <a href="#" id="article-bottom"></a> </div> <div class="col-narrow-1 mobile-hidden back-top" id="back-top"> <div class="panel-panel panel-region-left"> <div class="inside" id="back-top-inner"><div class="panel-pane pane-bmjj-back-to-top article-go-to-top" > <div class="pane-content"> <a href="#block-system-main" class="back-to-top" data-icon-position="" data-hide-link-title="0"><svg class="icon-article icon-arrow-up-top" aria-hidden="true"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="/sites/default/themes/bmjj/img/defs.svg#icon-arrow-up"></use></svg></a><a href="#article-bottom" class="back-to-top back-to-bottom" data-icon-position="" data-hide-link-title="0"><svg class="icon-article icon-arrow-up-top" aria-hidden="true"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="/sites/default/themes/bmjj/img/defs.svg#icon-arrow-down"></use></svg></a> </div> </div> </div> </div> </div> </div>  <div class="panel-row-wrapper panel-row-last row" id="article-bottom-row"> <div class="bottom-wrapper col-narrow-12"> <div class="panel-panel panel-region-bottom"> <div class="inside"><div class="panel-pane pane-snippet pane-footer-marketing-slots" > <div class="pane-content"> <div class="snippet footer-marketing-slots" id="footer-marketing-slots"> <div class="snippet-content"> <iframe data-src="https://jobs.bmj.com/widget/bootstrap/job/#i=180" class="optanon-category-3" id="mdgxWidgetiFrame" title="careers widget"></iframe> <script type="text/javascript" src="//trendmd.s3.amazonaws.com/trendmd.min.js"></script> <script type="text/plain" class="optanon-category-4">TrendMD.register( {journal_id: 39235, element: '#trendmd-suggestions', track_id: null} );</script> <div id="trendmd-suggestions"></div> </div> </div> </div> </div> </div> </div> </div> </div>  </div> </div> </div> </div> </div> </div> </div> </div> </section>  </div>  <footer role="contentinfo" class="section section-footer container-fluid" id="footer"> <section class="zone zone-footer row footer-journal-societies"> <div class="region region-footer col-narrow-12"> <div class="region-inner region-footer-inner"> <div class="region region-footersoc"> <div id="block-panels-mini-footer-society-images" class="block block-panels-mini" class="block block-panels-mini"> <div class="content"> <div class="panel-display panel-1col clearfix" id="mini-panel-footer_society_images"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-bmjj-societies-logos" > <div class="pane-content"> <ul><li><a href="http://www.bsg.org.uk/"><img src="https://resources.bmj.com/repository/journals-network-project/images/society-logos/society-logo-bsg.png" alt="British Society of Gastroenterology" /></a></li></ul> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </section> <section role="contentinfo" class="section section-footer"> <div class="zone zone-footer footer-links"> <nav class="row"> <div class="region region-footerlinks1"> <div id="block-menu-block-1" class="block block-menu-block" class="block block-menu-block"> <div class="content"> <div class="menu-block-wrapper menu-block-1 menu-name-menu-footer-menu-1 parent-mlid-0 menu-level-1"> <ul class="menu"><li class="first expanded menu-mlid-15078 col-mobile-12 col-narrow-3 col-normal-3 col-wide-3"><a href="/" class="" data-icon-position="" data-hide-link-title="0">Content</a><ul class="menu"><li class="first leaf menu-mlid-15079"><a href="/content/early/recent" class="" data-icon-position="" data-hide-link-title="0">Latest</a></li> <li class="leaf menu-mlid-15080"><a href="/content/current" class="" data-icon-position="" data-hide-link-title="0">Current issue</a></li> <li class="leaf menu-mlid-15081"><a href="/content/by/year" class="" data-icon-position="" data-hide-link-title="0">Archive</a></li> <li class="leaf menu-mlid-15082"><a href="http://gut.bmj.com/pages/education-in-gastroenterology" class="" data-icon-position="" data-hide-link-title="0">Education in Gastroenterology</a></li> <li class="leaf menu-mlid-15083"><a href="http://gut.bmj.com/pages/browse-by-topic/" class="" data-icon-position="" data-hide-link-title="0">Browse by collection</a></li> <li class="leaf menu-mlid-15084"><a href="https://gut.bmj.com/pages/visual-abstracts" class="" data-icon-position="" data-hide-link-title="0">Visual Abstracts</a></li> <li class="leaf menu-mlid-15085"><a href="http://gut.bmj.com/pages/most-read-articles/" class="" data-icon-position="" data-hide-link-title="0">Most read articles</a></li> <li class="leaf menu-mlid-15086"><a href="http://gut.bmj.com/pages/top-cited-articles/" class="" data-icon-position="" data-hide-link-title="0">Top cited articles</a></li> <li class="last leaf menu-mlid-15087"><a href="http://gut.bmj.com/pages/eletters" class="" data-icon-position="" data-hide-link-title="0">Responses</a></li> </ul></li> <li class="expanded menu-mlid-15088 col-mobile-12 col-narrow-3 col-normal-3 col-wide-3"><a href="/" class="" data-icon-position="" data-hide-link-title="0">Journal</a><ul class="menu"><li class="first leaf menu-mlid-15089"><a href="http://gut.bmj.com/pages/about/" class="" data-icon-position="" data-hide-link-title="0">About</a></li> <li class="leaf menu-mlid-15090"><a href="http://gut.bmj.com/site/about/edboard.xhtml" class="" data-icon-position="" data-hide-link-title="0">Editorial board</a></li> <li class="leaf menu-mlid-15091"><a href="https://myaccount.bmj.com/myaccount/signup.html?regService=etoc-alerts&corpusCode=gutjnl&fwdUrl=https://gut.bmj.com/" class="" data-icon-position="" data-hide-link-title="0">Sign up for email alerts</a></li> <li class="leaf menu-mlid-15092"><a href="http://gut.bmj.com/pages/subscribe/" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Subscribe</a></li> <li class="last leaf menu-mlid-15093"><a href="http://gut.bmj.com/pages/thank-you-to-our-reviewers/" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Thank you to our reviewers</a></li> </ul></li> <li class="expanded menu-mlid-15094 col-mobile-12 col-narrow-3 col-normal-3 col-wide-3"><a href="/" class="" data-icon-position="" data-hide-link-title="0">Authors</a><ul class="menu"><li class="first leaf menu-mlid-15095"><a href="http://gut.bmj.com/pages/authors/" class="" data-icon-position="" data-hide-link-title="0">Instructions for authors</a></li> <li class="leaf menu-mlid-15096"><a href="http://mc.manuscriptcentral.com/gut" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Submit an article paper</a></li> <li class="leaf menu-mlid-15097"><a href="http://authors.bmj.com/policies/" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Editorial policies</a></li> <li class="leaf menu-mlid-15098"><a href="http://openaccess.bmj.com/" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Open Access at BMJ</a></li> <li class="last leaf menu-mlid-15099"><a href="http://authors.bmj.com/" target="_blank" class="" data-icon-position="" data-hide-link-title="0">BMJ Author Hub</a></li> </ul></li> <li class="last expanded menu-mlid-15100 col-mobile-12 col-narrow-3 col-normal-3 col-wide-3"><a href="/" class="" data-icon-position="" data-hide-link-title="0">Help</a><ul class="menu"><li class="first leaf menu-mlid-15101"><a href="http://gut.bmj.com/pages/contact-us/" class="" data-icon-position="" data-hide-link-title="0">Contact us</a></li> <li class="leaf menu-mlid-15102"><a href="http://journals.bmj.com/cgi/reprintform" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Reprints</a></li> <li class="leaf menu-mlid-15103"><a href="http://www.bmj.com/company/products-services/rights-and-licensing/permissions" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Permissions</a></li> <li class="leaf menu-mlid-15104"><a href="https://www.bmj.com/company/for-advertisers-and-sponsor/" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Advertising</a></li> <li class="last leaf menu-mlid-15105"><a href="http://myaccount.bmj.com/myaccount/customerservice/salesforce-form.html" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Feedback form</a></li> </ul></li> </ul></div> </div> </div> </div> </nav> <div class="row"> <nav class="col-mobile-12 col-narrow-3 col-normal-3 col-wide-3"> <div class="region region-footersocial"> <div id="block-panels-mini-social-icons" class="block block-panels-mini" class="block block-panels-mini"> <div class="content"> <div class="panel-display panel-1col clearfix" id="mini-panel-social_icons"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-bmjj-social-icons" > <div class="pane-content"> <ul class="menu"><li class="leaf"><a href="http://gut.bmj.com/pages/rss-feeds" class="link-icon-only link-icon"><span class="icon icon-rss"></span><span class="title element-invisible"> RSS</span></a></li><li class="leaf"><a href="http://twitter.com/Gut_BMJ" class="link-icon-only link-icon"><span class="icon icon-twitter"></span><span class="title element-invisible"> Twitter</span></a></li><li class="leaf"><a href="http://www.facebook.com/Gut.BMJ" class="link-icon-only link-icon"><span class="icon icon-facebook"></span><span class="title element-invisible"> Facebook</span></a></li><li class="leaf"><a href="http://blogs.bmj.com/gut" class="link-icon-only link-icon"><span class="icon icon-blog"></span><span class="title element-invisible"> Blog</span></a></li><li class="leaf"><a href="https://soundcloud.com/bmjpodcasts/sets/gut-podcast" class="link-icon-only link-icon"><span class="icon icon-soundcloud"></span><span class="title element-invisible"> Soundcloud</span></a></li><li class="leaf"><a href="https://www.youtube.com/@GastroenterologyatBMJ-z9e" class="link-icon-only link-icon"><span class="icon icon-youtube"></span><span class="title element-invisible"> YouTube</span></a></li></ul> </div> </div> </div> </div> </div> </div> </div> </div> </nav> </div> </div> </section> <section class="row footer-platform"> <div class="col-mobile-12 col-narrow-4 logoBMJ"> <a href="http://www.bmj.com/company"><svg class="logo-bmj-svg" aria-hidden="true"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#logo-bmj"></use><svg></svg></svg></a> </div> <div class="col-mobile-12 col-narrow-8 legal"> <div class="legal-inner"> <ul> <li><a href="http://www.bmj.com/company/legal-information/">Website Terms & Conditions</a></li> <li><a href="http://www.bmj.com/company/your-privacy/">Privacy & Cookies</a></li> <li><a href="http://www.bmj.com/company/contact-us/">Contact BMJ</a></li> </ul>  <button id="ot-sdk-btn" class="ot-sdk-show-settings">Cookie Settings</button>  <p><small><span class="online-issn issn">Online ISSN: 1468-3288</span><span class="print-issn issn">Print ISSN: 0017-5749</span></small><br /> <small>Copyright 漏 2024 BMJ Publishing Group Ltd & British Society of Gastroenterology. All rights reserved.</small></p> </div> </div> </section> <div class="region region-absolute-bottom"> <div class="region-inner region-absolute-bottom-inner"> <div class="region region-absolute-bottom"> <div id="block-panels-mini-bottom-ad" class="block block-panels-mini text-center" class="block block-panels-mini text-center"> <div class="content"> <div class="panel-display one-layout " id="mini-panel-bottom_ad"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-dfp-pane" > <div class="pane-content"> <div id="dfp-ad-bottom-wrapper" class="dfp-tag-wrapper"> <div id="dfp-ad-bottom" class="dfp-tag-wrapper"> <script type="text/javascript"> googletag.cmd.push(function() { googletag.display("dfp-ad-bottom"); }); </script> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </footer> <script type="text/javascript" src="/sites/default/files/advagg_js/js__t3bgVPYyN8Eq6N439ldYeK9Gv2fJtkdYHadpxJJD7eo__8tErzMYnPJfFwN4Fv8PDe9_DUoLYbi0Fq9VwxsCzI4k__RBpwsggTa-66iCd391Lg7-ZmaIvHPOUAGYyVtdCScb8.js"></script> <script type="text/javascript" src="/sites/default/files/advagg_js/js__Jd5dsvNznZMdglFu8sSni1wCsUfzvQbApHPAZwt5TY4__65Mqa1DMRwcSvPxjJEn6BXgMm-ckF3oOvkUTG9HRADI__RBpwsggTa-66iCd391Lg7-ZmaIvHPOUAGYyVtdCScb8.js" defer="defer"></script> <script type="text/javascript" src="/sites/default/files/advagg_js/js__fUCEaCKUODF5P2WmzGzo1laxaEQ82Nl6oADDw5nONTE__bGuvhZW_EmWlwuA1fnxwF8mvZ1E1v3qbDTqQdQd0TS0__RBpwsggTa-66iCd391Lg7-ZmaIvHPOUAGYyVtdCScb8.js"></script> </body> </html>