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="//d1bxh8uas1mnw7.cloudfront.net" /> <link rel="dns-prefetch" href="//scholar.google.com" /> <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> <link rel="shortcut icon" href="https://gut.bmj.com/sites/default/themes/bmjj/favicon.ico" type="image/vnd.microsoft.icon" /> <meta name="viewport" content="width=device-width, initial-scale=1" /> <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","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":"main_tab","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> <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" /> <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="© 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’s 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’s 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 Clínica 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’s 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’s 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’s 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" /> <link rel="alternate" type="application/vnd.ms-powerpoint" title="Powerpoint" href="/content/73/2/361.ppt" /> <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__YFRuiqUdvK1yvVNb1oSBcGhrzBqGejYMOH-ZrKlO98U__AFX4RXDIciSUvyQgiiXaw6-hxp_0ISKrjNzVx1LaIoA__RBpwsggTa-66iCd391Lg7-ZmaIvHPOUAGYyVtdCScb8.js"></script> <script type="text/javascript" src="https://d1bxh8uas1mnw7.cloudfront.net/assets/embed.js"></script> <script type="text/javascript" src="/sites/default/files/advagg_js/js__RxmsdK7-WlnwoO5NREEVy8MRi0OqO4ZhkOHaMokGNlw__IAyE4mioyYmepJfxC77gDsM0J1xDyesxXH7WjkUNmyc__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 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" 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-2I33fWztAat-5W8xfTPl-TCpXJ5NIR1mM94J8Llj7PM" /> <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" 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" 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_610946373">Search for this keyword </label> <input placeholder="search" type="text" id="search_rightsidebar_keywords_610946373" 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_360533196" name="op" value="Search" class="form-submit" /><input type="hidden" name="form_build_id" value="form-YVwYY7gqWdZ7XQEusgGazk6aTTS8TN-oZLfGCGtwxQw" /> <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-6 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" 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_2109310967">Search for this keyword </label> <input placeholder="search" type="text" id="search_rightsidebar_keywords_2109310967" 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_965102829" name="op" value="Search" class="form-submit" /><input type="hidden" name="form_build_id" value="form-vj4b0WJHPlnA3jUNPICMxdb7xLUc6nl8TYDgMzZtkdo" /> <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-5 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" 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-mnJDtQEjojjdP89ItCOFvny83dD0K3GE9jRXgqnhJDY" /> <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" 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-article-text"></span>Article Text</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="active 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=""><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--21162451019" 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_tab_art" 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_tab_art"><div class="panel-display panel-1col clearfix" > <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-markup author-affiliates col-narrow-12 author-affiliates-corresp article" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><a href="http://orcid.org/0000-0002-3388-0660" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0002-3388-0660</a><span class="name">C Prakash Gyawali</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">1</a>, </li><li class="contributor" id="contrib-2"><span class="name">Rena Yadlapati</span><a id="xref-aff-2-1" class="xref-aff" href="#aff-2">2</a>, </li><li class="contributor" id="contrib-3"><span class="name">Ronnie Fass</span><a id="xref-aff-3-1" class="xref-aff" href="#aff-3">3</a>, </li><li class="contributor" id="contrib-4"><span class="name">David Katzka</span><a id="xref-aff-4-1" class="xref-aff" href="#aff-4">4</a>, </li><li class="contributor" id="contrib-5"><span class="name">John Pandolfino</span><a id="xref-aff-5-1" class="xref-aff" href="#aff-5">5</a>, </li><li class="contributor" id="contrib-6"><span class="name">Edoardo Savarino</span><a id="xref-aff-6-1" class="xref-aff" href="#aff-6">6</a>, </li><li class="contributor" id="contrib-7"><a href="http://orcid.org/0000-0002-4894-0523" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0002-4894-0523</a><span class="name">Daniel Sifrim</span><a id="xref-aff-7-1" class="xref-aff" href="#aff-7">7</a>, </li><li class="contributor" id="contrib-8"><span class="name">Stuart Spechler</span><a id="xref-aff-8-1" class="xref-aff" href="#aff-8">8</a>, </li><li class="contributor" id="contrib-9"><a href="http://orcid.org/0000-0002-6802-2121" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0002-6802-2121</a><span class="name">Frank Zerbib</span><a id="xref-aff-9-1" class="xref-aff" href="#aff-9">9</a>, </li><li class="contributor" id="contrib-10"><a href="http://orcid.org/0000-0003-4394-5584" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0003-4394-5584</a><span class="name">Mark R Fox</span><a id="xref-aff-10-1" class="xref-aff" href="#aff-10">10</a>, </li><li class="contributor" id="contrib-11"><span class="name">Shobna Bhatia</span><a id="xref-aff-11-1" class="xref-aff" href="#aff-11">11</a>, </li><li class="contributor" id="contrib-12"><span class="name">Nicola de Bortoli</span><a id="xref-aff-12-1" class="xref-aff" href="#aff-12">12</a>, </li><li class="contributor" id="contrib-13"><span class="name">Yu Kyung Cho</span><a id="xref-aff-13-1" class="xref-aff" href="#aff-13">13</a>, </li><li class="contributor" id="contrib-14"><span class="name">Daniel Cisternas</span><a id="xref-aff-14-1" class="xref-aff" href="#aff-14">14</a>, </li><li class="contributor" id="contrib-15"><a href="http://orcid.org/0000-0002-9084-8210" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0002-9084-8210</a><span class="name">Chien-Lin Chen</span><a id="xref-aff-15-1" class="xref-aff" href="#aff-15">15</a>, </li><li class="contributor" id="contrib-16"><span class="name">Charles Cock</span><a id="xref-aff-16-1" class="xref-aff" href="#aff-16">16</a>, </li><li class="contributor" id="contrib-17"><span class="name">Albis Hani</span><a id="xref-aff-17-1" class="xref-aff" href="#aff-17">17</a>, </li><li class="contributor" id="contrib-18"><span class="name">Jose Maria Remes Troche</span><a id="xref-aff-18-1" class="xref-aff" href="#aff-18">18</a>, </li><li class="contributor" id="contrib-19"><span class="name">Yinglian Xiao</span><a id="xref-aff-19-1" class="xref-aff" href="#aff-19">19</a>, </li><li class="contributor" id="contrib-20"><span class="name">Michael F Vaezi</span><a id="xref-aff-20-1" class="xref-aff" href="#aff-20">20</a>, </li><li class="last" id="contrib-21"><a href="http://orcid.org/0000-0002-7798-7638" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0002-7798-7638</a><span class="name">Sabine Roman</span><a id="xref-aff-21-1" class="xref-aff" href="#aff-21">21</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address> <sup>1</sup> <span class="institution">Division of Gastroenterology</span>, <span class="institution">Washington University School of Medicine</span>, <span class="addr-line">St Louis</span>, <span class="addr-line">Missouri</span>, USA </address></li><li class="aff"><a id="aff-2" name="aff-2"></a><address> <sup>2</sup> <span class="institution">Division of Gastroenterology</span>, <span class="institution">University of California in San Diego</span>, <span class="addr-line">La Jolla</span>, <span class="addr-line">California</span>, USA </address></li><li class="aff"><a id="aff-3" name="aff-3"></a><address> <sup>3</sup> <span class="institution">Medicine/Section of Gastroenterology</span>, <span class="institution">Case Western Reserve University</span>, <span class="addr-line">Cleveland</span>, <span class="addr-line">Ohio</span>, USA </address></li><li class="aff"><a id="aff-4" name="aff-4"></a><address> <sup>4</sup> <span class="institution">Gastroenterology and Hepatology</span>, <span class="institution">Columbia University</span>, <span class="addr-line">New York</span>, <span class="addr-line">New York</span>, USA </address></li><li class="aff"><a id="aff-5" name="aff-5"></a><address> <sup>5</sup> <span class="institution">Gastroenterology and Hepatology</span>, <span class="institution">Northwestern University Feinberg School of Medicine</span>, <span class="addr-line">Chicago</span>, <span class="addr-line">Illinois</span>, USA </address></li><li class="aff"><a id="aff-6" name="aff-6"></a><address> <sup>6</sup> <span class="institution">Department of Surgery, Oncology and Gastroenterology, Department of Medical and Surgical Specialties</span>, <span class="institution">University of Padua</span>, <span class="addr-line">Padova</span>, Italy </address></li><li class="aff"><a id="aff-7" name="aff-7"></a><address> <sup>7</sup> <span class="institution">Blizard Institute</span>, <span class="institution">Barts and The London School of Medicine and Dentistry</span>, <span class="addr-line">London</span>, UK </address></li><li class="aff"><a id="aff-8" name="aff-8"></a><address> <sup>8</sup> <span class="institution">Division of Gastroenterology</span>, <span class="institution">Baylor Scott and White North Texas</span>, <span class="addr-line">Dallas</span>, <span class="addr-line">Texas</span>, USA </address></li><li class="aff"><a id="aff-9" name="aff-9"></a><address> <sup>9</sup> <span class="institution">Gastroenterology</span>, <span class="institution">CHU de Bordeaux</span>, <span class="addr-line">Bordeaux</span>, France </address></li><li class="aff"><a id="aff-10" name="aff-10"></a><address> <sup>10</sup> <span class="institution">Gastroenterology</span>, <span class="institution">University of Zurich</span>, <span class="addr-line">Zurich</span>, Switzerland </address></li><li class="aff"><a id="aff-11" name="aff-11"></a><address> <sup>11</sup> <span class="institution">Gastroenterology</span>, <span class="institution">NIMS University</span>, <span class="addr-line">Jaipur</span>, India </address></li><li class="aff"><a id="aff-12" name="aff-12"></a><address> <sup>12</sup> <span class="institution">Division of Gastroenterology</span>, <span class="institution">University of Pisa</span>, <span class="addr-line">Pisa</span>, Italy </address></li><li class="aff"><a id="aff-13" name="aff-13"></a><address> <sup>13</sup> <span class="institution">Gastroenterology</span>, <span class="institution">Catholic University of Korea - Songsin Campus</span>, <span class="addr-line">Seoul</span>, Korea (the Republic of) </address></li><li class="aff"><a id="aff-14" name="aff-14"></a><address> <sup>14</sup> <span class="institution">Digestive System Research Unit</span>, <span class="institution">Universidad del Desarrollo Facultad de Medicina Clínica Alemana</span>, <span class="addr-line">Las Condes</span>, Chile </address></li><li class="aff"><a id="aff-15" name="aff-15"></a><address> <sup>15</sup> <span class="institution">Department of Medicine</span>, <span class="institution">Tzu Chi University</span>, <span class="addr-line">Hualien</span>, Taiwan </address></li><li class="aff"><a id="aff-16" name="aff-16"></a><address> <sup>16</sup> <span class="institution">Department of Gastroenterology and Hepatology</span>, <span class="institution">Flinders University</span>, <span class="addr-line">Adelaide</span>, <span class="addr-line">South Australia</span>, Australia </address></li><li class="aff"><a id="aff-17" name="aff-17"></a><address> <sup>17</sup> <span class="institution">Gastroenterology Unit, Department of Medicine</span>, <span class="institution">Pontificia Universidad Javeriana</span>, <span class="addr-line">Bogota</span>, Colombia </address></li><li class="aff"><a id="aff-18" name="aff-18"></a><address> <sup>18</sup> <span class="institution">Digestive Physiology and Motility Lab</span>, <span class="institution">Veracruzana University</span>, <span class="addr-line">Xalapa</span>, Mexico </address></li><li class="aff"><a id="aff-19" name="aff-19"></a><address> <sup>19</sup> <span class="institution">Department of Gastroenterology</span>, <span class="institution">Sun Yan-sen University of Medical Sciences</span>, <span class="addr-line">Guangzhou</span>, China </address></li><li class="aff"><a id="aff-20" name="aff-20"></a><address> <sup>20</sup> <span class="institution">Department of Medicine</span>, <span class="institution">Vanderbilt University</span>, <span class="addr-line">Nashville</span>, <span class="addr-line">Tennessee</span>, USA </address></li><li class="aff"><a id="aff-21" name="aff-21"></a><address> <sup>21</sup> <span class="institution">Department of Digestive Physiology</span>, <span class="institution">Universite de Lyon</span>, <span class="addr-line">Lyon</span>, France </address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1"><span class="corresp-label">Correspondence to</span> Professor C Prakash Gyawali, Washington University in St Louis, St Louis, Missouri, USA; <span class="em-link"><span class="em-addr">cprakash{at}wustl.edu</span></span> </li></ol></div></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-bmjj-learning-test col-narrow-12" > <div class="pane-content"> <p class="learning-link hidden-xs"><a href="https://learning.bmj.com/course-mapping?id=10.1136/gutjnl-2023-330616" target="_blank"><img src="/sites/default/modules/jnl_template_bmjj/plugins/content_types/images//logo-learning-take-the-test.png" alt="BMJ Learning - Take the Test"></a></p> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-markup abstract-with-bc" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" id="content-block" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><p id="p-2">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’s unique presentation will optimise GERD diagnosis and management.</p></div><ul class="kwd-group"><li class="kwd">GASTROESOPHAGEAL REFLUX DISEASE</li><li class="kwd">AMBULATORY pH MONITORING</li><li class="kwd">ENDOSCOPY</li></ul><div class="license" id="license-1"><span class="ali-license-ref"><a href="http://creativecommons.org/licenses/by-nc/4.0/" rel="license">http://creativecommons.org/licenses/by-nc/4.0/</a></span><p id="p-1">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: <a href="http://creativecommons.org/licenses/by-nc/4.0/" rel="license">http://creativecommons.org/licenses/by-nc/4.0/</a>.</p></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-dfp-pane oas-ads oas-ads-mid pull-right" > <div class="pane-content"> <div id="dfp-ad-mpu-wrapper" class="dfp-tag-wrapper"> <div id="dfp-ad-mpu" class="dfp-tag-wrapper"> <script type="text/javascript"> googletag.cmd.push(function() { googletag.display("dfp-ad-mpu"); }); </script> </div> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-custom pane-2" > <div class="pane-content"> <p><a href="https://doi.org/10.1136/gutjnl-2023-330616" target="_new">https://doi.org/10.1136/gutjnl-2023-330616</a></p> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-altmetrics" > <h2 class="pane-title">Statistics from Altmetric.com</h2> <div class="pane-content"> <div data-badge-details="right" data-badge-type="medium-donut" data-doi="10.1136/gutjnl-2023-330616" data-hide-no-mentions="true" class="altmetric-embed"></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-bmjj-jumplinks" > <div class="pane-content"> <div class="highwire-list-wrapper"><div class="highwire-list"><ul></ul></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-custom pane-3 permissions-box" > <h2 class="pane-title">Request Permissions</h2> <div class="pane-content"> <p>If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.</p> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-panels-ajax-pane-content permissions-box pane-highwire-permission-link" id="request-permissions"> <h2 class="pane-title"><span class='panels-ajax-pane-title' data-pid='new-70fd4c70-563e-4b94-ae3b-2a97f3980c13'></span></h2> <div class="pane-content"> <div class='panels-ajax-pane panels-ajax-pane-new-70fd4c70-563e-4b94-ae3b-2a97f3980c13' data-pid='new-70fd4c70-563e-4b94-ae3b-2a97f3980c13'></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-markup" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><ul class="kwd-group"><li class="kwd"><a href="/keyword/gastroesophageal-reflux-disease" class="hw-term hw-article-keyword hw-article-keyword-gastroesophageal-reflux-disease" rel="nofollow">GASTROESOPHAGEAL REFLUX DISEASE</a></li><li class="kwd"><a href="/keyword/ambulatory-ph-monitoring" class="hw-term hw-article-keyword hw-article-keyword-ambulatory-ph-monitoring" rel="nofollow">AMBULATORY pH MONITORING</a></li><li class="kwd"><a href="/keyword/endoscopy" class="hw-term hw-article-keyword hw-article-keyword-endoscopy" rel="nofollow">ENDOSCOPY</a></li></ul><p id="p-3">The Lyon Consensus proposes conclusive criteria for and against the diagnosis of gastro-oesophageal reflux disease (GERD), and adjunctive metrics that either consolidate or refute GERD diagnosis when primary criteria are inconclusive.<a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a> New published research indicates that testing strategies and thresholds differ when investigating patients with unproven versus proven GERD. The definition of GERD needed to be updated following improved specificity of diagnostic testing. Finally, as ROME V diagnostic criteria are being developed for oesophageal disorders of gut–brain interaction (DGBI), specific criteria for diagnosis and exclusion of GERD were needed that were consistent with emerging research. For several reasons (<a id="xref-table-wrap-1-1" class="xref-table" href="#T1">table 1</a>), an update of the original Lyon Consensus is essential and timely.</p><div id="T1" class="table pos-float"><div class="table-inline table-callout-links"><div class="callout"><span>View this table:</span><ul class="callout-links"><li class="view-inline first"><a href="" class="table-expand-inline" data-table-url="/highwire/markup/258790/expansion?postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed&table-expand-inline=1" data-icon-position="" data-hide-link-title="0">View inline</a></li> <li class="view-popup last"><a href="/highwire/markup/258790/expansion?width=1000&height=500&iframe=true&postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed" class="colorbox colorbox-load table-expand-popup" rel="gallery-fragment-tables" data-icon-position="" data-hide-link-title="0">View popup</a></li> </ul></div></div><div class="table-caption"><span class="table-label">Table 1</span> <p id="p-4" class="first-child">Justification of update of the Lyon Consensus</p><div class="sb-div caption-clear"></div></div></div><p id="p-6">The current update of the Lyon Consensus seeks to improve specificity of the modern diagnosis of GERD, to make oesophageal diagnostic algorithms congruent for identification of conclusive GERD, and for exclusion of GERD when favouring DGBI or other oesophageal disorders. Additionally, Lyon Consensus 2.0 defines GERD considering recent evidence, describes ‘actionable’ GERD where evidence from oesophageal testing supports revising, escalating or personalising GERD management, and identifies symptoms that have a high versus low likelihood of pathophysiological relationship to reflux episodes.</p><div class="section methods" id="sec-1"><h2 class="">Methods</h2><p id="p-7">The Lyon Consensus steering committee developed a strategy for this update in October 2022, and a core group reviewed recent literature. Five topics were identified as key areas in need of update (<a id="xref-table-wrap-1-2" class="xref-table" href="#T1">table 1</a>), and statements were developed to address these (<a id="xref-table-wrap-2-1" class="xref-table" href="#T2">table 2</a>). An international working group was assembled in January 2023, selected based on expertise in GERD diagnosis and management, ongoing research, geographical and gender representation as well as availability for virtual and in-person meetings. The core and working groups totalled 21 members, consisting of 20 voting members, and one non-voting member (MRF) who reviewed created content. The statements were further refined during virtual meetings in February–April 2023. The Lyon 2.0 core and working groups anonymously recorded levels of agreement for each statement using an electronic survey generated using REDCap and hosted at the University of California, San Diego.</p><div id="T2" class="table pos-float"><div class="table-inline table-callout-links"><div class="callout"><span>View this table:</span><ul class="callout-links"><li class="view-inline first"><a href="" class="table-expand-inline" data-table-url="/highwire/markup/258772/expansion?postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed&table-expand-inline=1" data-icon-position="" data-hide-link-title="0">View inline</a></li> <li class="view-popup last"><a href="/highwire/markup/258772/expansion?width=1000&height=500&iframe=true&postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed" class="colorbox colorbox-load table-expand-popup" rel="gallery-fragment-tables" data-icon-position="" data-hide-link-title="0">View popup</a></li> </ul></div></div><div class="table-caption"><span class="table-label">Table 2</span> <p id="p-8" class="first-child">Statements and levels of agreement among the core and working groups</p><div class="sb-div caption-clear"></div></div></div><p id="p-10">The RAND/University of California Los Angeles Appropriateness Methodology was used to assess levels of agreement. As per this methodology, members were instructed to apply their ranking to the average patient presenting to the average physician at an average facility, without considering cost implications, insurance reimbursement or feasibility at their individual centre. Each statement was ranked on a 9-point scale, where median scores of 1–3 were considered inappropriate, 4–6 were of uncertain appropriateness and 7–9 were considered appropriate and meeting agreement. Panel members provided input and statements of uncertain appropriateness were revised or consolidated after the first and second rounds of voting in March–April 2023. All revised and consolidated statements met appropriateness after the third round of voting, meeting the a priori threshold of 80% agreement (<a id="xref-table-wrap-2-2" class="xref-table" href="#T2">table 2</a>). The final meeting was held in May 2023.</p></div><div class="section" id="sec-2"><h2 class="">Statements</h2><div id="sec-3" class="subsection"><h3>GERD definition</h3><div id="sec-4" class="subsection"><h4><em>The modern definition of actionable GERD requires conclusive evidence of reflux-related pathology on endoscopy and/or abnormal reflux monitoring (using Lyon consensus thresholds) in the presence of compatible troublesome symptoms.</em></h4></div><div id="sec-5" class="subsection"><h4><em>Troublesome typical symptoms alone may be enough for antisecretory medication trials, but up-front oesophageal testing is suggested for all other symptom categories and in proton pump inhibitor (PPI) non-responders, prior to invasive GERD management or prior to long-term medical management.</em></h4><p id="p-11">Actionable GERD constitutes settings where management requires long-term acid suppression, an escalation of medical management, or consideration of interventional (ie, not easily reversible) management options for GERD such as laparoscopic fundoplication, magnetic sphincter augmentation (MSA), endoscopic GERD therapies or bariatric surgery, where high confidence in GERD diagnosis is essential.</p><p id="p-12">The Montreal consensus defines GERD as the reflux of stomach contents into the oesophagus causing troublesome symptoms and/or complications.<a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a> However, not all ‘troublesome’ symptoms can be directly linked to reflux of gastric content, and symptoms alone are insufficient for a conclusive diagnosis. Nevertheless, pragmatic continuation of empiric antisecretory therapy is considered appropriate when typical symptoms (heartburn, chest pain, regurgitation) improve with GERD treatment trials<a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3</a> (<a id="xref-fig-1-1" class="xref-fig" href="#F1">figure 1</a>), although response could also be due to placebo effect.<a id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4 5</a> In parallel, assumptions of GERD relationships with cough, hoarseness and other ‘isolated’ extraoesophageal symptoms (ie, in the absence of typical GERD symptoms) overestimated atypical GERD diagnoses leading to inappropriate use of antisecretory drugs, high economic burden and waste of limited testing resources<a id="xref-ref-6-1" class="xref-bibr" href="#ref-6">6 7</a> (<a id="xref-fig-1-2" class="xref-fig" href="#F1">figure 1</a>). Use of Lyon consensus criteria is anticipated to improve diagnostic specificity and confidence. While objective testing prior to long-term medical management of typical symptoms is optimal, practicality and cost-effectiveness need further study.</p><div id="F1" class="fig pos-float odd"><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="https://gut.bmj.com/content/gutjnl/73/2/361/F1.large.jpg?width=800&height=600&carousel=1" title="Troublesome typical and atypical symptoms suspicious for gastro-oesophageal reflux disease (GERD), and usual approach to evaluation of these symptoms. An empiric trial of antisecretory therapy is appropriate for typical symptoms in the absence of alarm symptoms. Prolonged wireless pH monitoring is most appropriate for quantification of reflux burden with typical symptoms, although pH-impedance or even pH only monitoring may be options depending on availability and expertise. Belching, cough and asthma may have a potential association with reflux episodes. Supragastric belching and rumination need to be identified, preferably using high-resolution impedance manometry (HRIM) and managed with behavioural therapy. Up-front testing is performed primarily to rule out a reflux basis for symptoms for all other atypical symptoms. Pulmonary evaluation and laryngoscopy serve to rule out primary non-GERD disorders, and may precede oesophageal physiological testing." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-148770542" data-figure-caption="<div class="highwire-markup">Troublesome typical and atypical symptoms suspicious for gastro-oesophageal reflux disease (GERD), and usual approach to evaluation of these symptoms. An empiric trial of antisecretory therapy is appropriate for typical symptoms in the absence of alarm symptoms. Prolonged wireless pH monitoring is most appropriate for quantification of reflux burden with typical symptoms, although pH-impedance or even pH only monitoring may be options depending on availability and expertise. Belching, cough and asthma may have a potential association with reflux episodes. Supragastric belching and rumination need to be identified, preferably using high-resolution impedance manometry (HRIM) and managed with behavioural therapy. Up-front testing is performed primarily to rule out a reflux basis for symptoms for all other atypical symptoms. Pulmonary evaluation and laryngoscopy serve to rule out primary non-GERD disorders, and may precede oesophageal physiological testing.</div>" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="Figure 1" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="https://gut.bmj.com/content/gutjnl/73/2/361/F1.medium.gif" width="440" height="215"/><noscript><img class="highwire-fragment fragment-image" alt="Figure 1" src="https://gut.bmj.com/content/gutjnl/73/2/361/F1.medium.gif" width="440" height="215"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="https://gut.bmj.com/content/gutjnl/73/2/361/F1.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download Figure 1" data-icon-position="" data-hide-link-title="0">Download figure</a></li> <li class="new-tab"><a href="https://gut.bmj.com/content/gutjnl/73/2/361/F1.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li> <li class="download-ppt last"><a href="/highwire/powerpoint/258831" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li> </ul></div><div class="fig-caption" xmlns:xhtml="http://www.w3.org/1999/xhtml"><span class="fig-label">Figure 1</span> <p id="p-13" class="first-child">Troublesome typical and atypical symptoms suspicious for gastro-oesophageal reflux disease (GERD), and usual approach to evaluation of these symptoms. An empiric trial of antisecretory therapy is appropriate for typical symptoms in the absence of alarm symptoms. Prolonged wireless pH monitoring is most appropriate for quantification of reflux burden with typical symptoms, although pH-impedance or even pH only monitoring may be options depending on availability and expertise. Belching, cough and asthma may have a potential association with reflux episodes. Supragastric belching and rumination need to be identified, preferably using high-resolution impedance manometry (HRIM) and managed with behavioural therapy. Up-front testing is performed primarily to rule out a reflux basis for symptoms for all other atypical symptoms. Pulmonary evaluation and laryngoscopy serve to rule out primary non-GERD disorders, and may precede oesophageal physiological testing.</p><div class="sb-div caption-clear"></div></div></div></div></div><div id="sec-6" class="subsection"><h3>GERD symptoms</h3><div id="sec-7" class="subsection"><h4><em>Typical symptoms of GERD consist of heartburn, oesophageal chest pain and regurgitation.</em></h4></div><div id="sec-8" class="subsection"><h4><em>The relationship of belching to reflux disease is variable, but belching can be part of reflux pathophysiology.</em></h4></div><div id="sec-9" class="subsection"><h4><em>Chronic cough and wheezing have a low but potential pathophysiological relationship to reflux disease.</em></h4></div><div id="sec-10" class="subsection"><h4><em>Hoarseness, globus, nausea, abdominal pain and other dyspeptic symptoms in the absence of typical symptoms have a low likelihood of pathophysiological relationship to reflux disease.</em></h4><p id="p-14">The modern diagnosis of GERD starts with identification of troublesome symptoms, but not all symptoms carry equal weight. Burning sensations beneath the breast bone (heartburn) or retrosternal chest pain may be interchangeable when responsive to empiric anti-secretory medication,<a id="xref-ref-8-1" class="xref-bibr" href="#ref-8">8</a> especially after a cardiac aetiology for chest pain is ruled out.<a id="xref-ref-9-1" class="xref-bibr" href="#ref-9">9</a> Approximately two-thirds to three-quarters of patients with heartburn, and half of patients with non-cardiac chest pain report response to short-term antisecretory therapy, but a 10%–25% placebo effect can confound this response; thus, response to an empiric PPI trial alone is insufficient for a conclusive GERD diagnosis.<a id="xref-ref-10-1" class="xref-bibr" href="#ref-10">10</a> Both heartburn and chest pain can arise from motor disorders (such as achalasia) and DGBI mechanisms.<a id="xref-ref-9-2" class="xref-bibr" href="#ref-9">9 11</a> </p><p id="p-15">Regurgitation, the effortless presence of sour or bitter gastric content in the mouth, often does not fully improve with acid suppression alone.<a id="xref-ref-12-1" class="xref-bibr" href="#ref-12">12</a> Acidic reflux episodes become weakly acidic or non-acidic following antisecretory therapy,<a id="xref-ref-13-1" class="xref-bibr" href="#ref-13">13</a> regurgitation of which can be an important mechanism for refractory GERD leading to clinically relevant, incremental decline in health-related quality of life.<a id="xref-ref-14-1" class="xref-bibr" href="#ref-14">14 15</a> Regurgitation needs differentiation from rumination, a subconsciously learnt postprandial behaviour, sometimes pleasurable, that typically stops when the regurgitate becomes acidic<a id="xref-ref-16-1" class="xref-bibr" href="#ref-16">16</a>; this can be mistaken for PPI-refractory GERD.<a id="xref-ref-17-1" class="xref-bibr" href="#ref-17">17</a> Rumination is treated with behavioural therapy rather than acid suppression or antireflux surgery (ARS) (<a id="xref-fig-1-3" class="xref-fig" href="#F1">figure 1</a>).<a id="xref-ref-18-1" class="xref-bibr" href="#ref-18">18</a> </p><p id="p-16">Both supragastric belching (where air ingested or injected into the oesophagus does not reach the stomach before eructation) and gastric belching (where air in the proximal stomach is vented during a transient LES relaxation) can trigger reflux.<a id="xref-ref-19-1" class="xref-bibr" href="#ref-19">19</a> Belching (and lack thereof, abelchia) can also be part of behavioural syndromes without pathological reflux (<a id="xref-fig-1-4" class="xref-fig" href="#F1">figure 1</a>).</p><p id="p-17">Chronic cough and wheezing have a significantly lower likelihood of direct reflux aetiology compared with typical symptoms (<a id="xref-fig-1-5" class="xref-fig" href="#F1">figure 1</a>). Chronic cough may represent hyper-responsive behaviour, where reflux is one of several triggers for coughing bouts, such as abrupt changes in temperature or humidity, prolonged talking or voice use, strong odours or scents, food triggers and postnasal drip.<a id="xref-ref-20-1" class="xref-bibr" href="#ref-20">20</a> Refluxate aspirated into the airways has been implicated in graft failure after lung transplant, and in the pathogenesis of idiopathic pulmonary fibrosis.<a id="xref-ref-21-1" class="xref-bibr" href="#ref-21">21 22</a> Wheezing and asthma may rarely be triggered by reflux, when aggressive reflux management may provide better control of asthma.<a id="xref-ref-23-1" class="xref-bibr" href="#ref-23">23</a> </p><p id="p-18">Data demonstrating response of globus to GERD management are scarce.<a id="xref-ref-24-1" class="xref-bibr" href="#ref-24">24</a> Hoarseness, throat clearing and sore throat have even less robust reflux associations,<a id="xref-ref-8-2" class="xref-bibr" href="#ref-8">8 25</a> and these symptoms often correlate with cognitive processes with or without reflux disease.<a id="xref-ref-26-1" class="xref-bibr" href="#ref-26">26</a> While dysphagia can be a consequence of reflux-induced oesophageal strictures or advanced erosive oesophagitis, primary dysphagia without heartburn, especially with bolus impaction, may suggest eosinophilic oesophagitis or a motility disorder. Finally, epigastric and abdominal symptoms (nausea, abdominal pain) are unlikely to have a reflux aetiology (<a id="xref-fig-1-6" class="xref-fig" href="#F1">figure 1</a>) where reflux monitoring is typically not recommended, the exception being mischaracterisation of heartburn as epigastric burning.<a id="xref-ref-27-1" class="xref-bibr" href="#ref-27">27</a> </p></div></div><div id="sec-11" class="subsection"><h3>GERD evidence</h3><div id="sec-12" class="subsection"><h4>Endoscopy</h4><div id="sec-13" class="subsection"><h5>LA grades B, C and D oesophagitis, biopsy proven Barrett’s oesophagus and peptic stricture are conclusive for a diagnosis of GERD.</h5><p id="p-19">Evidence of visible oesophageal mucosal damage typical of reflux induced injury and GERD-related complications (oesophageal stricture, Barrett’s oesophagus) are consistently associated with high reflux burden, and symptom improvement with GERD management.<a id="xref-ref-28-1" class="xref-bibr" href="#ref-28">28–31</a> The Los Angeles (LA) classification of erosive oesophagitis was established to provide a unifying global classification for oesophagitis.<a id="xref-ref-30-1" class="xref-bibr" href="#ref-30">30 32</a> Initial validation indicated that LA grade A oesophagitis had a kappa value of 0.65 and higher acid exposure time (AET) than non-erosive reflux disease (NERD) (9.3% vs 6.7%, respectively),<a id="xref-ref-32-1" class="xref-bibr" href="#ref-32">32</a> later studies have demonstrated grade A oesophagitis in 5%–7.5% of healthy subjects.<a id="xref-ref-29-1" class="xref-bibr" href="#ref-29">29 30 33 34</a> In contrast, LA grades B, C and D oesophagitis are highly uncommon in healthy subjects.<a id="xref-ref-29-2" class="xref-bibr" href="#ref-29">29</a> LA grade B oesophagitis demonstrated AET similar to grade C in the original validation study (13.7% vs 11.7%, respectively),<a id="xref-ref-32-2" class="xref-bibr" href="#ref-32">32</a> as well as in recent reports using wireless pH monitoring (8.23% vs 9.95%, respectively)<a id="xref-ref-29-3" class="xref-bibr" href="#ref-29">29</a> and pH-impedance monitoring (6.0% vs 8.7%, respectively).<a id="xref-ref-28-2" class="xref-bibr" href="#ref-28">28</a> Furthermore, symptom response with PPI is similar between LA grades B and C oesophagitis (74% vs 70%, respectively).<a id="xref-ref-28-3" class="xref-bibr" href="#ref-28">28</a> Grade D is associated with the highest mean AET among LA grades (19.1%).<a id="xref-ref-32-3" class="xref-bibr" href="#ref-32">32</a> </p><p id="p-20">These findings indicate that, contrary to the original Lyon Consensus, well-characterised LA grade B oesophagitis represents conclusive evidence for GERD and does not require further confirmation with reflux monitoring prior to management. However, objective GERD can overlap with DGBI phenotypes in symptomatic patients, which needs consideration when planning invasive GERD management options.<a id="xref-ref-35-1" class="xref-bibr" href="#ref-35">35</a> </p></div><div id="sec-14" class="subsection"><h5>To maximise the diagnostic yield, endoscopy should be performed 2–4 weeks after discontinuation of antisecretory therapy in unproven GERD.</h5><p id="p-21">Since mucosal healing occurs with PPIs in approximately 80%,<a id="xref-ref-36-1" class="xref-bibr" href="#ref-36">36</a> the likelihood of finding significant oesophagitis is greatly reduced if endoscopy is performed after 8 weeks of PPI therapy. To make a conclusive diagnosis in previously unproven GERD and to adequately phenotype patients to NERD versus erosive oesophagitis, endoscopy is optimally performed after withholding PPI therapy. If endoscopy is performed too soon, a lower grade of oesophagitis or no oesophagitis may be observed, which may not accurately represent the GERD phenotype. While several studies report endoscopic relapse of oesophagitis in approximately 70% at 6 months after PPI withdrawal,<a id="xref-ref-37-1" class="xref-bibr" href="#ref-37">37</a> the timing of relapse is unknown, and is probably related to pretreatment oesophagitis severity. In a small prospective study of 12 patients with healed LA grade C oesophagitis, discontinuation of therapy led to oesophagitis recurrence after just 1 week in 10 patients, with 5 patients demonstrating recurrent grade C oesophagitis after 2 weeks.<a id="xref-ref-38-1" class="xref-bibr" href="#ref-38">38</a> However, these results may not necessarily be extrapolated to lower grade oesophagitis. Therefore, for accurate GERD phenotyping, endoscopy should be performed after a minimum of 2 weeks but preferably 4 weeks after PPIs discontinuation.</p></div><div id="sec-15" class="subsection"><h5>LA grade B, C and D oesophagitis and recurrent peptic stricture on endoscopy while on optimised antisecretory therapy are indicative of refractory GERD.</h5><p id="p-22">The persistence of inflammatory and/or fibrotic mucosal lesions despite optimised PPI therapy is indicative of refractory GERD. Since most patients with refractory symptoms and proven GERD have a normal endoscopy, the presence of mucosal breaks consistent with LA grade B or greater despite 8 weeks of PPI therapy may reflect poorly controlled acid reflux despite downstaging of initial oesophagitis grade.<a id="xref-ref-39-1" class="xref-bibr" href="#ref-39">39</a> Regardless whether patients are symptomatic or not, this should be considered diagnostic of ongoing or treatment-refractory GERD.<a id="xref-ref-39-2" class="xref-bibr" href="#ref-39">39</a> </p></div></div></div><div id="sec-16" class="subsection"><h3>Ambulatory reflux monitoring</h3><div id="sec-17" class="subsection"><h4>Choice of ambulatory reflux monitoring methodology</h4><div id="sec-18" class="subsection"><h5>Prolonged wireless pH-monitoring off antisecretory therapy is the preferred diagnostic tool in unproven GERD when available and may provide highest diagnostic yield with study duration of 96 hours.</h5><p id="p-23">As many as 70% of symptomatic patients have endoscopically normal oesophageal mucosa. During this index endoscopy, a wireless pH probe can be placed to monitor AET for up to 96 hours, which takes day-to-day AET variation into account, with better patient tolerance while also shortening diagnostic delay.<a id="xref-ref-40-1" class="xref-bibr" href="#ref-40">40–45</a> The prognostic performance of wireless reflux monitoring was significantly higher with 72–96 hours monitoring compared with data from the first 48 hours (area under curve (AUC) 0.63 for 96-hour data vs 0.57 for 48-hour data, p=0.01), which implies an inherent benefit over 24-hour pH monitoring despite lack of high-quality head-to head-comparisons.<a id="xref-ref-46-1" class="xref-bibr" href="#ref-46">46</a> The third and fourth days of wireless pH monitoring add significantly to determining a dominant physiological versus pathological AET pattern, and allow discontinuation of PPI when a dominant physiological pattern is identified.<a id="xref-ref-42-1" class="xref-bibr" href="#ref-42">42 45 46</a> Thus, 96-hour pH monitoring predicts discontinuation of PPI versus ongoing need for PPI therapy better than shorter durations of monitoring (<a id="xref-fig-2-1" class="xref-fig" href="#F2">figure 2</a>). However, wireless pH monitoring is not available, feasible or affordable worldwide. Ambulatory catheter-based reflux monitoring remains a viable alternative, and each clinician needs to personalise the optimal testing option for individual patients, taking resources, cost and patient presentation into consideration.</p><div id="F2" class="fig pos-float odd"><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="https://gut.bmj.com/content/gutjnl/73/2/361/F2.large.jpg?width=800&height=600&carousel=1" title="The presence or absence of prior conclusive evidence for gastro-oesophageal reflux disease determines test strategy and methodology. When conclusive GERD evidence is absent (unproven GERD), testing is performed to establish or refute the presence of GERD, hence ambulatory reflux monitoring is performed off antisecretory therapy. Wireless pH monitoring and catheter based pH or pH monitoring are alternatives, based on local feasibility, availability and cost of each technique. Conclusive GERD evidence, and borderline evidence with supportive adjunctive metrics according to the Lyon Consensus (figure 3) serve to provide evidence of GERD. In contrast, when symptoms persist despite adequate therapy of previously proven GERD, pH-impedance monitoring is performed on therapy to look for evidence for treatment refractory GERD necessitating management escalation. AET, acid exposure time; GERD, gastro-oesophageal reflux disease; LA, Los Angeles; MNBI, mean nocturnal baseline impedance." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-148770542" data-figure-caption="<div class="highwire-markup">The presence or absence of prior conclusive evidence for gastro-oesophageal reflux disease determines test strategy and methodology. When conclusive GERD evidence is absent (unproven GERD), testing is performed to establish or refute the presence of GERD, hence ambulatory reflux monitoring is performed off antisecretory therapy. Wireless pH monitoring and catheter based pH or pH monitoring are alternatives, based on local feasibility, availability and cost of each technique. Conclusive GERD evidence, and borderline evidence with supportive adjunctive metrics according to the Lyon Consensus (figure 3) serve to provide evidence of GERD. In contrast, when symptoms persist despite adequate therapy of previously proven GERD, pH-impedance monitoring is performed on therapy to look for evidence for treatment refractory GERD necessitating management escalation. AET, acid exposure time; GERD, gastro-oesophageal reflux disease; LA, Los Angeles; MNBI, mean nocturnal baseline impedance.</div>" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="Figure 2" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="https://gut.bmj.com/content/gutjnl/73/2/361/F2.medium.gif" width="440" height="182"/><noscript><img class="highwire-fragment fragment-image" alt="Figure 2" src="https://gut.bmj.com/content/gutjnl/73/2/361/F2.medium.gif" width="440" height="182"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="https://gut.bmj.com/content/gutjnl/73/2/361/F2.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download Figure 2" data-icon-position="" data-hide-link-title="0">Download figure</a></li> <li class="new-tab"><a href="https://gut.bmj.com/content/gutjnl/73/2/361/F2.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li> <li class="download-ppt last"><a href="/highwire/powerpoint/258759" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li> </ul></div><div class="fig-caption"><span class="fig-label">Figure 2</span> <p id="p-24" class="first-child">The presence or absence of prior conclusive evidence for gastro-oesophageal reflux disease determines test strategy and methodology. When conclusive GERD evidence is absent (unproven GERD), testing is performed to establish or refute the presence of GERD, hence ambulatory reflux monitoring is performed off antisecretory therapy. Wireless pH monitoring and catheter based pH or pH monitoring are alternatives, based on local feasibility, availability and cost of each technique. Conclusive GERD evidence, and borderline evidence with supportive adjunctive metrics according to the Lyon Consensus (<a id="xref-fig-3-1" class="xref-fig" href="#F3">figure 3</a>) serve to provide evidence of GERD. In contrast, when symptoms persist despite adequate therapy of previously proven GERD, pH-impedance monitoring is performed on therapy to look for evidence for treatment refractory GERD necessitating management escalation. AET, acid exposure time; GERD, gastro-oesophageal reflux disease; LA, Los Angeles; MNBI, mean nocturnal baseline impedance.</p><div class="sb-div caption-clear"></div></div></div></div><div id="sec-19" class="subsection"><h5>Ambulatory pH-impedance monitoring off antisecretory therapy has diagnostic value in unproven GERD when typical reflux symptoms are associated with excessive belching, when rumination is suspected, and when pulmonary symptoms are being evaluated for association with GERD.</h5><p id="p-25">While pH-impedance monitoring performed off PPI provides similar 24-hour AET data as catheter-based pH monitoring or day 1 of wireless pH monitoring, more reflux episodes are detected because of higher sensitivity of the impedance component in identifying reflux episodes independent of pH.<a id="xref-ref-47-1" class="xref-bibr" href="#ref-47">47</a> Accurate reflux episode counts predict GERD symptom response when elevated, especially in regurgitation-predominant GERD,<a id="xref-ref-48-1" class="xref-bibr" href="#ref-48">48</a> although expert interpretation is required to overcome inaccuracies of automated analysis.<a id="xref-ref-49-1" class="xref-bibr" href="#ref-49">49</a> Additionally, the use of pH-impedance monitoring over pH monitoring alone shifts diagnoses from functional heartburn to reflux hypersensitivity, since additional reflux episodes identified irrespective of acidic content using pH-impedance monitoring may be associated with symptoms.<a id="xref-ref-50-1" class="xref-bibr" href="#ref-50">50 51</a> Mean nocturnal baseline impedance (MNBI) measurement from pH-impedance monitoring provides longitudinal evidence of reflux-induced mucosal damage,<a id="xref-ref-52-1" class="xref-bibr" href="#ref-52">52–54</a> but postreflux swallow induced peristaltic wave (PSPW) analysis remains predominantly a research tool useful in phenotyping rather than diagnosing GERD.<a id="xref-ref-52-2" class="xref-bibr" href="#ref-52">52 55–57</a> </p><p id="p-26">High AET is uncommon in patients with ‘isolated’ extraoesophageal symptoms, and pH-impedance monitoring seems to improve diagnostic yield,<a id="xref-ref-58-1" class="xref-bibr" href="#ref-58">58</a> partly because of the added value of reflux number counts, reflux-symptom association testing, and parameters like MNBI. A study of 156 patients with chronic cough undergoing pH-impedance found that pathological AET and low baseline impedance increased the probability of PPI response.<a id="xref-ref-59-1" class="xref-bibr" href="#ref-59">59</a> In small prospective cohorts of patients with laryngeal symptoms and laryngoscopic signs suspicious for reflux, pH-impedance testing off PPI therapy confirmed GERD in less than a fifth of patients independent of symptoms or laryngoscopic findings, suggesting that pH-impedance monitoring up front has important value in identifying the select few patients with extraoesophageal symptoms who could benefit from antireflux therapy<a id="xref-ref-58-2" class="xref-bibr" href="#ref-58">58 60</a> (<a id="xref-fig-1-7" class="xref-fig" href="#F1">figure 1</a>). Up-front physiological testing is more cost-effective than empiric PPI therapy with extra-oesophageal symptoms, given the high numbers needed to treat for PPI response.<a id="xref-ref-8-3" class="xref-bibr" href="#ref-8">8 61</a> </p><p id="p-27">Ambulatory pH-impedance monitoring is the gold standard for diagnosing supragastric belching, identified as rapid anterograde increase in intraoesophageal impedance, followed by prompt retrograde decline to baseline values.<a id="xref-ref-19-2" class="xref-bibr" href="#ref-19">19</a> Using pH-impedance monitoring, supragastric belching episodes were identified in 48% of 50 consecutive GERD patients (median 13 episodes/24 hours) compared with median 2 episodes in 50% of 10 healthy volunteers.<a id="xref-ref-62-1" class="xref-bibr" href="#ref-62">62</a> In contrast, rumination episodes are not distinguishable from reflux episodes on pH-impedance monitoring, but typically extend to the proximal oesophagus, with prompt symptom reporting and higher prevalence in the immediate postprandial period,.<a id="xref-ref-17-2" class="xref-bibr" href="#ref-17">17 63</a> </p><p id="p-28">Thus, pH-impedance monitoring off antisecretory therapy has the same indications as wireless pH monitoring, and has particular value when evaluating belching, predominant regurgitation, and supraoesophageal or pulmonary symptoms (<a id="xref-fig-2-2" class="xref-fig" href="#F2">figure 2</a>). Catheter-based pH monitoring will suffice when pH-impedance monitoring is not available, but this technique cannot detect supragastric belching or rumination, and has lower sensitivity for accurate reflux episode counts which compromises reflux-symptom association.</p></div><div id="sec-20" class="subsection"><h5>Ambulatory pH-impedance monitoring on PPI is of value in proven GERD with persisting symptoms despite optimal therapy.</h5><p id="p-29">When pH-only testing is performed on PPI, very low AET values are recorded: median AET was 1.2% on once-daily PPI and 0.3% on a twice-daily regimen in 131 patients with both typical and atypical reflux symptoms.<a id="xref-ref-64-1" class="xref-bibr" href="#ref-64">64</a> Similarly low values were reported in 66 healthy volunteers undergoing pH-impedance testing on twice-daily PPI.<a id="xref-ref-65-1" class="xref-bibr" href="#ref-65">65</a> Although acidic reflux episodes generally become weakly acidic or non-acidic on PPI, both can be detected using pH-impedance monitoring, and symptoms could be triggered by persisting reflux episodes independent of pH.<a id="xref-ref-13-2" class="xref-bibr" href="#ref-13">13</a> In a study of 39 patients with refractory reflux symptoms tested both on therapy (pH-impedance monitoring) and off therapy (wireless pH monitoring), abnormal AET off therapy was associated with weakly acid reflux episodes on therapy.<a id="xref-ref-66-1" class="xref-bibr" href="#ref-66">66</a> Further, MNBI from pH-impedance monitoring on therapy may have diagnostic value, while PSPW remains a research tool in further phenotyping patients with previously proven GERD.<a id="xref-ref-56-1" class="xref-bibr" href="#ref-56">56 67 68</a> </p><p id="p-30">Ambulatory pH-impedance monitoring performed on antisecretory medications may help decision-making regarding escalation of GERD management beyond pharmacotherapy. In a randomised trial comparing ARS to medical management in patients with heartburn incompletely responding to PPI, although the likelihood of abnormal reflux burden on pH-impedance monitoring was small (78 patients from a starting cohort of 366 patients, 21%), ARS resulted in symptom relief in 67% among 27 patients, in contrast to 28% with continued medical management (p<0.001).<a id="xref-ref-69-1" class="xref-bibr" href="#ref-69">69</a> In another study of 85 patients with heartburn and regurgitation in the context of previously proven GERD studied with pH-impedance testing on twice a day PPI regimen, AET>4.0% and/or >80 reflux episodes resulted in 85% reporting symptom benefit from MSA when this was offered, especially when regurgitation was the dominant symptom (93%) compared with heartburn (60%).<a id="xref-ref-65-2" class="xref-bibr" href="#ref-65">65</a> Abnormal pH-impedance metrics on once-daily PPI therapy normalised with maximal PPI therapy in 71.1% of 45 symptomatic patients.<a id="xref-ref-70-1" class="xref-bibr" href="#ref-70">70</a> Further, 89% of 38 patients with refractory reflux symptoms and abnormal pH-impedance metrics on maximal PPI therapy benefited from ARS on retrospective analysis.<a id="xref-ref-70-2" class="xref-bibr" href="#ref-70">70</a> </p><p id="p-31">Thus, in patients with proven GERD and persisting symptoms, pH-impedance monitoring on therapy can help phenotype patients and identify ongoing reflux burden that may respond to ARS, irrespective of how GERD was previously proven<a id="xref-ref-3-2" class="xref-bibr" href="#ref-3">3 71</a> (<a id="xref-fig-2-3" class="xref-fig" href="#F2">figure 2</a>).</p></div></div></div><div id="sec-21" class="subsection"><h3>Metrics and thresholds useful in ambulatory reflux monitoring</h3><div id="sec-22" class="subsection"><h4>Wireless pH monitoring</h4><div id="sec-23" class="subsection"><h5>AET<4.0% on all days of wireless pH monitoring with negative reflux-symptom association excludes GERD.</h5><p id="p-32">A recent study examining various AET thresholds on wireless pH monitoring identified AET<4.0% with the highest predictive value for PPI discontinuation while maintaining a minimal symptom burden.<a id="xref-ref-42-2" class="xref-bibr" href="#ref-42">42</a> Studies using wireless pH monitoring in healthy controls have also demonstrated predominance of median AET<4.0%, thus supporting the Lyon Consensus designation of AET<4.0% as physiological acid exposure.<a id="xref-ref-29-4" class="xref-bibr" href="#ref-29">29 45</a> Further, the number of days with AET<4.0% was of prognostic value, where the odds of PPI discontinuation was 10 times greater with AET<4.0% across all 4 days of monitoring.<a id="xref-ref-42-3" class="xref-bibr" href="#ref-42">42</a> Therefore, in patients with unproven GERD who report heartburn, regurgitation and/or oesophageal chest pain, AET<4.0% across all days of prolonged wireless pH monitoring off PPI therapy excludes pathological GERD.</p></div><div id="sec-24" class="subsection"><h5>AET>6.0% for ≥2 days is diagnostic of GERD and supports treatment for GERD.</h5><p id="p-33">AET>6.0% denotes pathological oesophageal acid burden.<a id="xref-ref-1-2" class="xref-bibr" href="#ref-1">1</a> Patients meeting the threshold of ≥2 days with AET>6% are more likely to have symptoms, especially typical GERD symptoms, higher GERDQ scores, erosive oesophagitis and higher likelihood of needing PPI therapy.<a id="xref-ref-29-5" class="xref-bibr" href="#ref-29">29 42 45</a> Therefore, AET>6% on at least 2 days of wireless pH monitoring is diagnostic of GERD requiring treatment.<a id="xref-ref-41-1" class="xref-bibr" href="#ref-41">41 45</a> </p></div><div id="sec-25" class="subsection"><h5>AET<4.0% on all days with a positive reflux-symptom association meets criteria for reflux hypersensitivity.</h5><p id="p-34">Positive symptom association probability (>95%) and/or symptom index >50% increase confidence that symptoms may be linked to reflux episodes.<a id="xref-ref-1-3" class="xref-bibr" href="#ref-1">1</a> Rome IV posits that positive reflux-symptom association with physiological AET establishes reflux hypersensitivity as a mechanism for symptoms, where neuromodulators may complement antisecretory therapy.<a id="xref-ref-72-1" class="xref-bibr" href="#ref-72">72</a> However, reflux-symptom association may not always be reliable, since it relies on prompt patient reporting of perceived symptoms within a 2 min window.<a id="xref-ref-73-1" class="xref-bibr" href="#ref-73">73</a> </p></div><div id="sec-26" class="subsection"><h5>Any prolonged reflux monitoring study that does not meet criteria for GERD, reflux hypersensitivity or a normal study is considered inconclusive for GERD.</h5><p id="p-35">When AET is between 4.0% and 6.0%, further clinical context and additional test data are needed to determine the need for GERD management,<a id="xref-ref-1-4" class="xref-bibr" href="#ref-1">1</a> since other conditions including reflux hypersensitivity, motility disorders and behavioural disorders such as supragastric belching and rumination may be contributing to patient symptoms. This is supported by data from studies on healthy volunteers where 20% had dominant borderline AET values across 4 days of recording despite being asymptomatic,<a id="xref-ref-45-1" class="xref-bibr" href="#ref-45">45</a> and patients with normal endoscopy and low-grade oesophagitis (LA Grade A) had AET values overlapping this borderline range.<a id="xref-ref-29-6" class="xref-bibr" href="#ref-29">29</a> </p></div></div><div id="sec-27" class="subsection"><h4>pH-impedance monitoring</h4><div id="sec-28" class="subsection"><h5>Total AET>6% off PPI on ambulatory pH-impedance monitoring is diagnostic of GERD and supports treatment for GERD.</h5><p id="p-36">Among the various oesophageal pH monitoring parameters acquired from catheter-based studies, total AET>6% off antisecretory medications has long been considered the most reproducible and specific metric for identifying GERD that will respond to medical or surgical treatment.<a id="xref-ref-1-5" class="xref-bibr" href="#ref-1">1 74</a> Thresholds for pH-impedance metrics have been based on small single-region studies using inconsistent criteria for confirming reflux events. Noting these limitations, one recent study performed expert consensus analysis of 391 impedance-pH tracings from countries around the world using either the Diversatek or Laborie systems.<a id="xref-ref-75-1" class="xref-bibr" href="#ref-75">75</a> The investigators identified normative thresholds for AET that substantiate the Lyon Consensus threshold (<4%), with significant differences between Diversatek (95th percentile 2.8%) and Laborie (95th percentile 5%) systems, and significant differences across countries and regions. Thus, clinical interpretation of pH-impedance monitoring studies should take into account these substantial system-related and region-related differences in normal impedance-pH monitoring thresholds.</p></div><div id="sec-29" class="subsection"><h5>Total reflux episodes <40/day is adjunctive evidence for absence of pathological GERD.</h5></div><div id="sec-30" class="subsection"><h5>Total reflux episodes 40–80/day off PPI is inconclusive evidence for GERD as a stand-alone metric.</h5></div><div id="sec-31" class="subsection"><h5>Total reflux episodes >80/day is adjunctive evidence for objective GERD.</h5></div><div id="sec-32" class="subsection"><h5>There are not sufficient data regarding thresholds for upright versus supine reflux episode numbers, and acidic versus non-acidic reflux events to incorporate these findings into clinical practice.</h5><p id="p-37">In addressing the clinical relevance of numbers of reflux episodes, a study of off-therapy pH-impedance tracings from 488 patients with PPI-dependent heartburn and 70 healthy controls showed that a threshold value of 40 reflux episodes significantly differentiated patients from controls.<a id="xref-ref-53-1" class="xref-bibr" href="#ref-53">53</a> An expert consensus analysis of 391 pH-impedance studies performed in healthy volunteers demonstrated system differences between Diversatek (95th percentile 55 episodes) and Laborie (95th percentile 78 episodes), with considerable regional variability.<a id="xref-ref-75-2" class="xref-bibr" href="#ref-75">75</a> A post hoc analysis of 123 patients with troublesome regurgitation on once-daily PPI randomised to twice-daily PPI or MSA found that reduction of total reflux episodes to physiological levels (especially to <35) was associated with improved treatment outcomes, while a preoperative finding of >80 reflux episodes despite twice-daily PPI predicted satisfaction with the outcome of MSA.<a id="xref-ref-48-2" class="xref-bibr" href="#ref-48">48</a> </p><p id="p-38">In a study of 67 patients with weakly acidic reflux (defined on 24-hour pH-impedance monitoring performed off PPIs as AET<4.2% and total reflux episodes>40), MSA resulted in significant improvements in GERD-related symptoms and quality of life.<a id="xref-ref-76-1" class="xref-bibr" href="#ref-76">76</a> Another study evaluated 72 patients with GERD symptoms who had 24-hour pH-impedance monitoring performed off PPIs.<a id="xref-ref-77-1" class="xref-bibr" href="#ref-77">77</a> Using abnormal AET as the gold-standard for GERD diagnosis, AUC analysis showed that a threshold of ≥41 total reflux episodes was optimally sensitive and specific for identifying GERD (sensitivity 69.6%, specificity 80.7%, AUC 0.83, 95% cCI 0.73 to 0.92), although this does not identify reflux episodes as an independent predictor of GERD.<a id="xref-ref-77-2" class="xref-bibr" href="#ref-77">77</a> </p><p id="p-39">These data support maintaining the reflux episode thresholds for physiological reflux (<40 reflux episodes) and pathological reflux (>80 reflux episodes) defined by the Lyon consensus, with 40–80 reflux episodes deemed inconclusive for GERD as a stand-alone metric.</p></div><div id="sec-33" class="subsection"><h5>Combination of AET>4% and >80 reflux episodes/day on an optimised antisecretory regimen is evidence for actionable refractory GERD.</h5><p id="p-40">A retrospective study evaluated pH-impedance tracings performed on PPIs in 66 healthy volunteers, 43 patients with proven heartburn-predominant GERD, and 42 with proven regurgitation-predominant GERD.<a id="xref-ref-65-3" class="xref-bibr" href="#ref-65">65</a> When the two GERD groups were pooled for ROC analysis, an AET threshold of 0.5% predicted PPI-non-response with sensitivity of only 0.62, specificity 0.51, AUC 0.58, p=0.22. However, a reflux episode threshold count of 40 performed considerably better with sensitivity 0.80, specificity 0.51, AUC 0.70, p=0.002. The combination of AET>4% and >80 reflux episodes had sensitivity and specificity of 0.50 and 0.71 for predicting PPI non-response; 85% of patients with these parameters who underwent escalation of GERD management to ARS or MSA improved symptomatically. In another study that evaluated 366 patients with persistent heartburn despite bid PPI therapy, an AET threshold of 4.2% (and/or positive symptom association probability) was used to define refractory GERD; using this definition, 67% of 27 patients randomised to ARS improved.<a id="xref-ref-69-2" class="xref-bibr" href="#ref-69">69</a> These findings suggest that AET of 4.0% and 80 reflux episodes define a need for escalation of reflux management.</p></div></div></div><div id="sec-34" class="subsection"><h3>Baseline impedance</h3><div id="sec-35" class="subsection"><h4><em>Baseline impedance of <1500 ohms is adjunctive evidence for GERD, while baseline impedance >2500 ohms is evidence against pathological GERD.</em></h4><p id="p-41">Oesophageal baseline impedance is a marker of oesophageal mucosal integrity, and may add value towards GERD diagnosis, especially when AET is inconclusive.<a id="xref-ref-54-1" class="xref-bibr" href="#ref-54">54</a> The original description measures MNBI averaged from three different 10 min periods during the supine period that excludes the effect of swallows and reflux episodes.<a id="xref-ref-78-1" class="xref-bibr" href="#ref-78">78</a> Another method averages impedance values during the entire supine period.<a id="xref-ref-79-1" class="xref-bibr" href="#ref-79">79</a> Both methods have excellent correlation with each other and can discriminate GERD patients from healthy subjects.</p><p id="p-42">A multicentre international study of healthy asymptomatic subjects undergoing pH-impedance monitoring off PPI demonstrated the fifth percentile MNBI value of 1500 ohms at 3 and 5 cm above the LES, implying impaired oesophageal mucosal integrity below this threshold.<a id="xref-ref-75-3" class="xref-bibr" href="#ref-75">75</a> Patients with conclusive GERD based on abnormal AET have been demonstrated to have MNBI values consistently below 1500 ohms.<a id="xref-ref-80-1" class="xref-bibr" href="#ref-80">80</a> Median values in healthy asymptomatic subjects and symptomatic subjects with normal AET were consistently >2500 ohms.<a id="xref-ref-75-4" class="xref-bibr" href="#ref-75">75 80</a> </p></div></div></div><div class="section" id="sec-36"><h2 class="">Updated criteria for modern diagnosis of GERD</h2><p id="p-43">The Lyon Consensus 2.0 updates oesophageal test parameters that either conclusively establish or rule out the presence of GERD (<a id="xref-fig-3-2" class="xref-fig" href="#F3">figure 3</a>). The existing Lyon Consensus criteria have been updated based on new research, and parameters that have not functioned as diagnostic criteria have been retired (<a id="xref-table-wrap-3-1" class="xref-table" href="#T3">table 3</a>). The concepts of unproven and proven GERD are used in recommendations of testing methodology, options, metrics and thresholds. Additionally, Lyon Consensus 2.0 proposes a modern definition of GERD and describes symptoms with high versus low likelihood of objective GERD.</p><div id="F3" class="fig pos-float odd"><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="https://gut.bmj.com/content/gutjnl/73/2/361/F3.large.jpg?width=800&height=600&carousel=1" title="Findings that establish conclusive evidence for gastro-oesophageal reflux disease (GERD) can be acquired from endoscopy and/or ambulatory reflux monitoring off therapy in unproven GERD. When evidence is borderline, adjunctive evidence on endoscopy, pH-impedance monitoring and manometry can sway confidence towards or away from conclusive GERD. Findings on pH-impedance monitoring or wireless pH monitoring can establish absence of GERD, especially when endoscopy is also normal. Similar levels of conclusive, borderline and adjunctive metrics are described for endoscopy and pH-impedance monitoring performed on optimised antisecretory therapy. AET, acid exposure time; HRM, high-resolution manometry; IEM: ineffective esophageal motilityl LA, Los Angeles; MNBI, mean nocturnal baseline impedance." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-148770542" data-figure-caption="<div class="highwire-markup">Findings that establish conclusive evidence for gastro-oesophageal reflux disease (GERD) can be acquired from endoscopy and/or ambulatory reflux monitoring off therapy in unproven GERD. When evidence is borderline, adjunctive evidence on endoscopy, pH-impedance monitoring and manometry can sway confidence towards or away from conclusive GERD. Findings on pH-impedance monitoring or wireless pH monitoring can establish absence of GERD, especially when endoscopy is also normal. Similar levels of conclusive, borderline and adjunctive metrics are described for endoscopy and pH-impedance monitoring performed on optimised antisecretory therapy. AET, acid exposure time; HRM, high-resolution manometry; IEM: ineffective esophageal motilityl LA, Los Angeles; MNBI, mean nocturnal baseline impedance.</div>" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="Figure 3" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="https://gut.bmj.com/content/gutjnl/73/2/361/F3.medium.gif" width="440" height="222"/><noscript><img class="highwire-fragment fragment-image" alt="Figure 3" src="https://gut.bmj.com/content/gutjnl/73/2/361/F3.medium.gif" width="440" height="222"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="https://gut.bmj.com/content/gutjnl/73/2/361/F3.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download Figure 3" data-icon-position="" data-hide-link-title="0">Download figure</a></li> <li class="new-tab"><a href="https://gut.bmj.com/content/gutjnl/73/2/361/F3.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li> <li class="download-ppt last"><a href="/highwire/powerpoint/258781" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li> </ul></div><div class="fig-caption"><span class="fig-label">Figure 3</span> <p id="p-44" class="first-child">Findings that establish conclusive evidence for gastro-oesophageal reflux disease (GERD) can be acquired from endoscopy and/or ambulatory reflux monitoring off therapy in unproven GERD. When evidence is borderline, adjunctive evidence on endoscopy, pH-impedance monitoring and manometry can sway confidence towards or away from conclusive GERD. Findings on pH-impedance monitoring or wireless pH monitoring can establish absence of GERD, especially when endoscopy is also normal. Similar levels of conclusive, borderline and adjunctive metrics are described for endoscopy and pH-impedance monitoring performed on optimised antisecretory therapy. AET, acid exposure time; HRM, high-resolution manometry; IEM: ineffective esophageal motilityl LA, Los Angeles; MNBI, mean nocturnal baseline impedance.</p><div class="sb-div caption-clear"></div></div></div><div id="T3" class="table pos-float"><div class="table-inline table-callout-links"><div class="callout"><span>View this table:</span><ul class="callout-links"><li class="view-inline first"><a href="" class="table-expand-inline" data-table-url="/highwire/markup/258816/expansion?postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed&table-expand-inline=1" data-icon-position="" data-hide-link-title="0">View inline</a></li> <li class="view-popup last"><a href="/highwire/markup/258816/expansion?width=1000&height=500&iframe=true&postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed" class="colorbox colorbox-load table-expand-popup" rel="gallery-fragment-tables" data-icon-position="" data-hide-link-title="0">View popup</a></li> </ul></div></div><div class="table-caption"><span class="table-label">Table 3</span> <p id="p-45" class="first-child">Changes from original (Lyon 1.0) to updated (Lyon 2.0) criteria for the modern diagnosis of GERD</p><div class="sb-div caption-clear"></div></div></div><p id="p-47">In light of recent reports<a id="xref-ref-28-4" class="xref-bibr" href="#ref-28">28 29</a> that corroborate evidence from early descriptions of the LA grading of oesophagitis,<a id="xref-ref-30-2" class="xref-bibr" href="#ref-30">30</a> endoscopic identification of LA grades B, C and D establish the diagnosis of GERD, and the diagnosis of refractory GERD if endoscopy is performed on optimised antisecretory therapy. While dedicated histopathological scoring of oesophageal biopsies,<a id="xref-ref-81-1" class="xref-bibr" href="#ref-81">81</a> and especially use of electron microscopy to identify dilated intercellular spaces<a id="xref-ref-82-1" class="xref-bibr" href="#ref-82">82</a> can differentiate GERD from non-GERD DGBI, routine biopsies have suboptimal performance characteristics in supporting or refuting a conclusive GERD diagnosis.<a id="xref-ref-39-3" class="xref-bibr" href="#ref-39">39 83</a> Further, the diagnostic yield of oesophageal biopsies in identifying eosinophilic oesophagitis in refractory heartburn is negligible in the absence of dysphagia or endoscopic abnormalities (0% and 1.9%, respectively), and are therefore not recommended unless there are clinical symptoms (eg, dysphagia) or endoscopic suspicion of eosinophilic oesophagitis.<a id="xref-ref-84-1" class="xref-bibr" href="#ref-84">84</a> In vivo endoscopic evaluation of oesophageal mucosal integrity was first studied using impedance electrodes incorporated into a catheter introduced through the biopsy channel of an endoscope; a second-generation device had electrode arrays mounted on an inflatable balloon to facilitate mucosal contact; neither method is currently available.<a id="xref-ref-85-1" class="xref-bibr" href="#ref-85">85 86</a> A novel endoscopic cap device that evaluates short segments of the oesophageal mucosa is under development and normative thresholds are being acquired; this has potential to identify GERD-related changes in mucosal integrity from non-GERD phenotypes at index endoscopy. Finally, a normal endoscopic examination does not rule out GERD, but identification of a hiatus hernia during endoscopy can be associated with increased reflux burden.</p><p id="p-48">The updated Lyon Consensus introduces metrics for use of prolonged wireless pH monitoring (Medtronic) in unproven GERD with typical symptoms, if available and affordable.<a id="xref-ref-42-4" class="xref-bibr" href="#ref-42">42</a> Modern calibration-free wireless probes can be conveniently deployed at short notice if conclusive GERD evidence is not identified on index endoscopy performed off antisecretory therapy, and interpretation is now simplified for the average endoscopist using a concordant or dominant daily AET pattern.<a id="xref-ref-41-2" class="xref-bibr" href="#ref-41">41 45</a> A second manufacturer (Laborie) has launched a wireless pH probe. Thus, wireless pH monitoring can be a convenient option both for the patient and the operator.</p><p id="p-49">The Lyon Consensus continues to support catheter-based pH-impedance for reflux monitoring, which provides accurate assessment of acidic, non-acidic and gaseous reflux episodes, of particular value when regurgitation, belching and pulmonary symptoms are being evaluated. Interpretation requires expertise, as automated interpretation may overcall or misidentify reflux episodes.<a id="xref-ref-49-2" class="xref-bibr" href="#ref-49">49</a> Catheter-based pH-impedance on therapy remains the only reflux monitoring modality that can identify refractory reflux in symptomatic proven GERD patients, and metrics are now defined.<a id="xref-ref-65-4" class="xref-bibr" href="#ref-65">65</a> Baseline impedance thresholds are now defined that conform to reliably normal, conclusively abnormal and inconclusive values, based on normative data as well as available research. However, since baseline impedance values can be abnormal in non-reflux inflammation and with fluid stasis in oesophageal hypomotility or achalasia, this parameter remains adjunctive. Conversely, PSPW may have value in phenotyping refractory GERD rather than in GERD diagnosis; further, normative thresholds are variable and calculation is cumbersome.<a id="xref-ref-56-2" class="xref-bibr" href="#ref-56">56 75</a> </p><p id="p-50">High-resolution manometry (HRM) rules out achalasia spectrum disorders in PPI non-responders.<a id="xref-ref-87-1" class="xref-bibr" href="#ref-87">87</a> While HRM findings cannot diagnose GERD, abnormal EGJ morphology (ie, hiatus hernia), a compromised EGJ barrier and oesophageal hypomotility (especially using Chicago Classification 4.0 criteria) often associate with abnormal AET or erosive oesophagitis.<a id="xref-ref-88-1" class="xref-bibr" href="#ref-88">88–90</a> Hence, these HRM findings remain supportive for the diagnosis of GERD.</p><p id="p-51">The Lyon Consensus endorses the concepts of unproven and proven GERD in directing evaluation of symptomatic patients. When no prior conclusive evidence of GERD exists on endoscopy or ambulatory reflux monitoring (unproven GERD), further testing seeks to determine if conclusive GERD exists, hence testing is performed off therapy (<a id="xref-fig-2-4" class="xref-fig" href="#F2">figure 2</a>). In contrast, if prior conclusive GERD evidence exists, persisting symptoms on therapy require evaluation for refractoriness of acid or reflux burden despite management, which may include the need for escalation of therapy, endoscopic or surgical intervention. In recognition of these differences between unproven versus proven GERD, testing options and thresholds for conclusive GERD versus absence of GERD are now provided.</p><p id="p-52">The Lyon Consensus evolves in concert with advances in GERD diagnosis. The utilisation of testing at index endoscopy is anticipated to grow, hence mucosal integrity assessment using an endoscopic device has potential t o direct further evaluation. Artificial intelligence will likely impact diagnostic and therapeutic paradigms within GERD, particularly in interpretation of reflux monitoring. Personalisation of management to each patient’s unique presentation will help further optimise GERD diagnosis and management. Future iterations of the Lyon Consensus will attempt to keep pace with new research.</p></div><div class="section ethics-statement" id="sec-37"><h2 class="">Ethics statements</h2><div class="section" id="sec-38"><h3>Patient consent for publication</h3><p id="p-58" class="ethics-consent-to-publish">Not applicable.</p></div></div><div class="section ref-list" id="ref-list-1"><h2 class="">References</h2><ol class="cit-list"><li><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1 in text" id="ref-1">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.1" data-doi="10.1136/gutjnl-2017-314722"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Gyawali</span> <span class="cit-name-given-names">CP</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Kahrilas</span> <span class="cit-name-given-names">PJ</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Savarino</span> <span class="cit-name-given-names">E</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Modern diagnosis of GERD: the lyon consensus</span>. <abbr class="cit-jnl-abbrev">Gut</abbr> <span class="cit-pub-date">2018</span>;<span class="cit-vol">67</span>:<span class="cit-fpage">1351</span>–<span class="cit-lpage">62</span>. <a href="http://dx.doi.org/10.1136/gutjnl-2017-314722">doi:10.1136/gutjnl-2017-314722</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DGut%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fgutjnl-2017-314722%26rft_id%253Dinfo%253Apmid%252F29437910%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NjoiZ3V0am5sIjtzOjU6InJlc2lkIjtzOjk6IjY3LzcvMTM1MSI7czo0OiJhdG9tIjtzOjIxOiIvZ3V0am5sLzczLzIvMzYxLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2 in text" id="ref-2">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.2" data-doi="10.1111/j.1572-0241.2006.00630.x"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Vakil</span> <span class="cit-name-given-names">N</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">van Zanten</span> <span class="cit-name-given-names">SV</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Kahrilas</span> <span class="cit-name-given-names">P</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus</span>. <abbr class="cit-jnl-abbrev">Am J Gastroenterol</abbr> <span class="cit-pub-date">2006</span>;<span class="cit-vol">101</span>:<span class="cit-fpage">1900</span>–<span class="cit-lpage">20</span>; <a href="http://dx.doi.org/10.1111/j.1572-0241.2006.00630.x">doi:10.1111/j.1572-0241.2006.00630.x</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DThe%2BAmerican%2Bjournal%2Bof%2Bgastroenterology%26rft.stitle%253DAm%2BJ%2BGastroenterol%26rft.aulast%253DVakil%26rft.auinit1%253DN.%26rft.volume%253D101%26rft.issue%253D8%26rft.spage%253D1900%26rft.epage%253D1920%26rft.atitle%253DThe%2BMontreal%2Bdefinition%2Band%2Bclassification%2Bof%2Bgastroesophageal%2Breflux%2Bdisease%253A%2Ba%2Bglobal%2Bevidence-based%2Bconsensus.%26rft_id%253Dinfo%253Adoi%252F10.1111%252Fj.1572-0241.2006.00630.x%26rft_id%253Dinfo%253Apmid%252F16928254%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1111/j.1572-0241.2006.00630.x&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=16928254&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=000239962000032&link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3 in text" id="ref-3">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.3"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Yadlapati</span> <span class="cit-name-given-names">R</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Gyawali</span> <span class="cit-name-given-names">CP</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Pandolfino</span> <span class="cit-name-given-names">JE</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">AGA clinical practice update on the personalized approach to the evaluation and management of GERD: expert review</span>. <abbr class="cit-jnl-abbrev">Clinical Gastroenterology and Hepatology</abbr> <span class="cit-pub-date">2022</span>;<span class="cit-vol">20</span>:<span class="cit-fpage">984</span>–<span class="cit-lpage">994</span>. <a href="http://dx.doi.org/10.1016/j.cgh.2022.01.025">doi:10.1016/j.cgh.2022.01.025</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DClinical%2BGastroenterology%2Band%2BHepatology%26rft.volume%253D20%26rft.spage%253D984%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4 in text" id="ref-4">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.4" data-doi="10.1136/gut.2009.200063"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Dent</span> <span class="cit-name-given-names">J</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Vakil</span> <span class="cit-name-given-names">N</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Jones</span> <span class="cit-name-given-names">R</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Accuracy of the diagnosis of GORD by questionnaire, physicians and a trial of proton pump inhibitor treatment: the diamond study</span>. <abbr class="cit-jnl-abbrev">Gut</abbr> <span class="cit-pub-date">2010</span>;<span class="cit-vol">59</span>:<span class="cit-fpage">714</span>–<span class="cit-lpage">21</span>. <a href="http://dx.doi.org/10.1136/gut.2009.200063">doi:10.1136/gut.2009.200063</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DGut%26rft.stitle%253DGut%26rft.aulast%253DDent%26rft.auinit1%253DJ.%26rft.volume%253D59%26rft.issue%253D6%26rft.spage%253D714%26rft.epage%253D721%26rft.atitle%253DAccuracy%2Bof%2Bthe%2Bdiagnosis%2Bof%2BGORD%2Bby%2Bquestionnaire%252C%2Bphysicians%2Band%2Ba%2Btrial%2Bof%2Bproton%2Bpump%2Binhibitor%2Btreatment%253A%2Bthe%2BDiamond%2BStudy%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fgut.2009.200063%26rft_id%253Dinfo%253Apmid%252F20551454%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NjoiZ3V0am5sIjtzOjU6InJlc2lkIjtzOjg6IjU5LzYvNzE0IjtzOjQ6ImF0b20iO3M6MjE6Ii9ndXRqbmwvNzMvMi8zNjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 5 in text" id="ref-5">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.5"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Ghoneim</span> <span class="cit-name-given-names">S</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Wang</span> <span class="cit-name-given-names">J</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">El Hage Chehade</span> <span class="cit-name-given-names">N</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Diagnostic accuracy of the proton pump inhibitor test in gastroesophageal reflux disease and noncardiac chest pain: a systematic review and meta-analysis</span>. <abbr class="cit-jnl-abbrev">J Clin Gastroenterol</abbr> <span class="cit-pub-date">2023</span>;<span class="cit-vol">57</span>:<span class="cit-fpage">380</span>–<span class="cit-lpage">8</span>. <a href="http://dx.doi.org/10.1097/MCG.0000000000001686">doi:10.1097/MCG.0000000000001686</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DJ%2BClin%2BGastroenterol%26rft.volume%253D57%26rft.spage%253D380%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-6-1" title="View reference 6 in text" id="ref-6">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.6" data-doi="10.1038/ajg.2013.69"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Francis</span> <span class="cit-name-given-names">DO</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Rymer</span> <span class="cit-name-given-names">JA</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Slaughter</span> <span class="cit-name-given-names">JC</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">High economic burden of caring for patients with suspected extraesophageal reflux</span>. <abbr class="cit-jnl-abbrev">Am J Gastroenterol</abbr> <span class="cit-pub-date">2013</span>;<span class="cit-vol">108</span>:<span class="cit-fpage">905</span>–<span class="cit-lpage">11</span>. <a href="http://dx.doi.org/10.1038/ajg.2013.69">doi:10.1038/ajg.2013.69</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DAm%2BJ%2BGastroenterol%26rft.volume%253D108%26rft.spage%253D905%26rft_id%253Dinfo%253Adoi%252F10.1038%252Fajg.2013.69%26rft_id%253Dinfo%253Apmid%252F23545710%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1038/ajg.2013.69&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=23545710&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-6-1" title="View reference 7 in text" id="ref-7">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.7" data-doi="10.1016/j.ejim.2016.10.007"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Savarino</span> <span class="cit-name-given-names">V</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Dulbecco</span> <span class="cit-name-given-names">P</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">de Bortoli</span> <span class="cit-name-given-names">N</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">The appropriate use of proton pump inhibitors (Ppis): need for a reappraisal</span>. <abbr class="cit-jnl-abbrev">Eur J Intern Med</abbr> <span class="cit-pub-date">2017</span>;<span class="cit-vol">37</span>:<span class="cit-fpage">19</span>–<span class="cit-lpage">24</span>. <a href="http://dx.doi.org/10.1016/j.ejim.2016.10.007">doi:10.1016/j.ejim.2016.10.007</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DEur%2BJ%2BIntern%2BMed%26rft.volume%253D37%26rft.spage%253D19%26rft_id%253Dinfo%253Adoi%252F10.1016%252Fj.ejim.2016.10.007%26rft_id%253Dinfo%253Apmid%252F27784575%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1016/j.ejim.2016.10.007&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=27784575&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-8-1" title="View reference 8 in text" id="ref-8">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.8"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Gyawali</span> <span class="cit-name-given-names">CP</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Fass</span> <span class="cit-name-given-names">R</span> </span> </li></ol><cite>. <span class="cit-article-title">Management of gastroesophageal reflux disease</span>. <abbr class="cit-jnl-abbrev">Gastroenterology</abbr> <span class="cit-pub-date">2018</span>;<span class="cit-vol">154</span>:<span class="cit-fpage">302</span>–<span class="cit-lpage">18</span>. <a href="http://dx.doi.org/10.1053/j.gastro.2017.07.049">doi:10.1053/j.gastro.2017.07.049</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DGastroenterology%26rft.volume%253D154%26rft.spage%253D302%26rft_id%253Dinfo%253Apmid%252Fhttp%253A%252F%252Fwww.n%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=http://www.n&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-9-1" title="View reference 9 in text" id="ref-9">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.9"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Fass</span> <span class="cit-name-given-names">R</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Achem</span> <span class="cit-name-given-names">SR</span> </span> </li></ol><cite>. <span class="cit-article-title">Noncardiac chest pain: diagnostic evaluation</span>. <abbr class="cit-jnl-abbrev">Dis Esophagus</abbr> <span class="cit-pub-date">2012</span>;<span class="cit-vol">25</span>:<span class="cit-fpage">89</span>–<span class="cit-lpage">101</span>. <a href="http://dx.doi.org/10.1111/j.1442-2050.2011.01225.x">doi:10.1111/j.1442-2050.2011.01225.x</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DDiseases%2Bof%2Bthe%2Besophagus%2B%253A%2B%2Bofficial%2Bjournal%2Bof%2Bthe%2BInternational%2BSociety%2Bfor%2BDiseases%2Bof%2Bthe%2BEsophagus%2B%252F%2BI.S.D.E%26rft.stitle%253DDis%2BEsophagus%26rft.aulast%253DFass%26rft.auinit1%253DR.%26rft.volume%253D25%26rft.issue%253D2%26rft.spage%253D89%26rft.epage%253D101%26rft.atitle%253DNoncardiac%2Bchest%2Bpain%253A%2Bdiagnostic%2Bevaluation.%26rft_id%253Dinfo%253Apmid%252F21777340%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=21777340&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-10-1" title="View reference 10 in text" id="ref-10">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.10" data-doi="10.1136/gutjnl-2013-306393"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Boeckxstaens</span> <span class="cit-name-given-names">G</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">El-Serag</span> <span class="cit-name-given-names">HB</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Smout</span> <span class="cit-name-given-names">AJPM</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Symptomatic reflux disease: the present, the past and the future</span>. <abbr class="cit-jnl-abbrev">Gut</abbr> <span class="cit-pub-date">2014</span>;<span class="cit-vol">63</span>:<span class="cit-fpage">1185</span>–<span class="cit-lpage">93</span>. <a href="http://dx.doi.org/10.1136/gutjnl-2013-306393">doi:10.1136/gutjnl-2013-306393</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DGut%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fgutjnl-2013-306393%26rft_id%253Dinfo%253Apmid%252F24607936%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NjoiZ3V0am5sIjtzOjU6InJlc2lkIjtzOjk6IjYzLzcvMTE4NSI7czo0OiJhdG9tIjtzOjIxOiIvZ3V0am5sLzczLzIvMzYxLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-9-2" title="View reference 11 in text" id="ref-11">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.11" data-doi="10.1136/gut.51.6.885"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Fass</span> <span class="cit-name-given-names">R</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Tougas</span> <span class="cit-name-given-names">G</span> </span> </li></ol><cite>. <span class="cit-article-title">Functional Heartburn: the stimulus, the pain, and the brain</span>. <abbr class="cit-jnl-abbrev">Gut</abbr> <span class="cit-pub-date">2002</span>;<span class="cit-vol">51</span>:<span class="cit-fpage">885</span>–<span class="cit-lpage">92</span>. <a href="http://dx.doi.org/10.1136/gut.51.6.885">doi:10.1136/gut.51.6.885</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DGut%26rft.stitle%253DGut%26rft.aulast%253DFass%26rft.auinit1%253DR%26rft.volume%253D51%26rft.issue%253D6%26rft.spage%253D885%26rft.epage%253D892%26rft.atitle%253DFunctional%2Bheartburn%253A%2Bthe%2Bstimulus%252C%2Bthe%2Bpain%252C%2Band%2Bthe%2Bbrain%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fgut.51.6.885%26rft_id%253Dinfo%253Apmid%252F12427796%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NjoiZ3V0am5sIjtzOjU6InJlc2lkIjtzOjg6IjUxLzYvODg1IjtzOjQ6ImF0b20iO3M6MjE6Ii9ndXRqbmwvNzMvMi8zNjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-12-1" title="View reference 12 in text" id="ref-12">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.12" data-doi="10.1038/ajg.2011.146"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Kahrilas</span> <span class="cit-name-given-names">PJ</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Howden</span> <span class="cit-name-given-names">CW</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Hughes</span> <span class="cit-name-given-names">N</span> </span> </li></ol><cite>. <span class="cit-article-title">Response of regurgitation to proton pump inhibitor therapy in clinical trials of gastroesophageal reflux disease</span>. <abbr class="cit-jnl-abbrev">Am J Gastroenterol</abbr> <span class="cit-pub-date">2011</span>;<span class="cit-vol">106</span>:<span class="cit-fpage">1419</span>–<span class="cit-lpage">25</span>; <a href="http://dx.doi.org/10.1038/ajg.2011.146">doi:10.1038/ajg.2011.146</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DThe%2BAmerican%2Bjournal%2Bof%2Bgastroenterology%26rft.stitle%253DAm%2BJ%2BGastroenterol%26rft.aulast%253DKahrilas%26rft.auinit1%253DP.%2BJ.%26rft.volume%253D106%26rft.issue%253D8%26rft.spage%253D1419%26rft.epage%253D1425%26rft.atitle%253DResponse%2Bof%2Bregurgitation%2Bto%2Bproton%2Bpump%2Binhibitor%2Btherapy%2Bin%2Bclinical%2Btrials%2Bof%2Bgastroesophageal%2Breflux%2Bdisease.%26rft_id%253Dinfo%253Adoi%252F10.1038%252Fajg.2011.146%26rft_id%253Dinfo%253Apmid%252F21537361%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1038/ajg.2011.146&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=21537361&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-13-1" title="View reference 13 in text" id="ref-13">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.13" data-doi="10.1053/gast.2001.24840"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Vela</span> <span class="cit-name-given-names">MF</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Camacho-Lobato</span> <span class="cit-name-given-names">L</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Srinivasan</span> <span class="cit-name-given-names">R</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Simultaneous Intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: effect of omeprazole</span>. <abbr class="cit-jnl-abbrev">Gastroenterology</abbr> <span class="cit-pub-date">2001</span>;<span class="cit-vol">120</span>:<span class="cit-fpage">1599</span>–<span class="cit-lpage">606</span>. <a href="http://dx.doi.org/10.1053/gast.2001.24840">doi:10.1053/gast.2001.24840</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DGastroenterology%26rft.stitle%253DGastroenterology%26rft.aulast%253DVELA%26rft.auinit1%253DM.%2BF.%26rft.volume%253D120%26rft.issue%253D7%26rft.spage%253D1599%26rft.epage%253D1606%26rft.atitle%253DSimultaneous%2BIntraesophageal%2BImpedance%2Band%2BpH%2BMeasurement%2Bof%2BAcid%2Band%2BNonacid%2BGastroesophageal%2BReflux%253A%2BEffect%2Bof%2BOmeprazole%26rft_id%253Dinfo%253Adoi%252F10.1053%252Fgast.2001.24840%26rft_id%253Dinfo%253Apmid%252F11375942%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1053/gast.2001.24840&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=11375942&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=000169004000009&link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-14-1" title="View reference 14 in text" id="ref-14">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.14" data-doi="10.1136/gutjnl-2013-304883"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Kahrilas</span> <span class="cit-name-given-names">PJ</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Jonsson</span> <span class="cit-name-given-names">A</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Denison</span> <span class="cit-name-given-names">H</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Impact of regurgitation on health-related quality of life in gastro-oesophageal reflux disease before and after short-term potent acid suppression therapy</span>. <abbr class="cit-jnl-abbrev">Gut</abbr> <span class="cit-pub-date">2014</span>;<span class="cit-vol">63</span>:<span class="cit-fpage">720</span>–<span class="cit-lpage">6</span>. <a href="http://dx.doi.org/10.1136/gutjnl-2013-304883">doi:10.1136/gutjnl-2013-304883</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DGut%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fgutjnl-2013-304883%26rft_id%253Dinfo%253Apmid%252F23831734%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NjoiZ3V0am5sIjtzOjU6InJlc2lkIjtzOjg6IjYzLzUvNzIwIjtzOjQ6ImF0b20iO3M6MjE6Ii9ndXRqbmwvNzMvMi8zNjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-14-1" title="View reference 15 in text" id="ref-15">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.15"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Kahrilas</span> <span class="cit-name-given-names">PJ</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Howden</span> <span class="cit-name-given-names">CW</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Wernersson</span> <span class="cit-name-given-names">B</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Impact of persistent, frequent regurgitation on quality of life in Heartburn responders treated with acid suppression: a multinational primary care study</span>. <abbr class="cit-jnl-abbrev">Aliment Pharmacol Ther</abbr> <span class="cit-pub-date">2013</span>;<span class="cit-vol">37</span>:<span class="cit-fpage">1005</span>–<span class="cit-lpage">10</span>. <a href="http://dx.doi.org/10.1111/apt.12298">doi:10.1111/apt.12298</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DAliment%2BPharmacol%2BTher%26rft.volume%253D37%26rft.spage%253D1005%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-16-1" title="View reference 16 in text" id="ref-16">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.16"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Kessing</span> <span class="cit-name-given-names">BF</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Smout</span> <span class="cit-name-given-names">AJPM</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Bredenoord</span> <span class="cit-name-given-names">AJ</span> </span> </li></ol><cite>. <span class="cit-article-title">Current diagnosis and management of the rumination syndrome</span>. <abbr class="cit-jnl-abbrev">J Clin Gastroenterol</abbr> <span class="cit-pub-date">2014</span>;<span class="cit-vol">48</span>:<span class="cit-fpage">478</span>–<span class="cit-lpage">83</span>. <a href="http://dx.doi.org/10.1097/MCG.0000000000000142">doi:10.1097/MCG.0000000000000142</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DJ%2BClin%2BGastroenterol%26rft.volume%253D48%26rft.spage%253D478%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-17-1" title="View reference 17 in text" id="ref-17">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.17"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Nakagawa</span> <span class="cit-name-given-names">K</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Sawada</span> <span class="cit-name-given-names">A</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Hoshikawa</span> <span class="cit-name-given-names">Y</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-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</span>. <abbr class="cit-jnl-abbrev">Am J Gastroenterol</abbr> <span class="cit-pub-date">2019</span>;<span class="cit-vol">114</span>:<span class="cit-fpage">1248</span>–<span class="cit-lpage">55</span>. <a href="http://dx.doi.org/10.14309/ajg.0000000000000295">doi:10.14309/ajg.0000000000000295</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DAm%2BJ%2BGastroenterol%26rft.volume%253D114%26rft.spage%253D1248%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-18-1" title="View reference 18 in text" id="ref-18">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.18"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Murray</span> <span class="cit-name-given-names">HB</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Juarascio</span> <span class="cit-name-given-names">AS</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Di Lorenzo</span> <span class="cit-name-given-names">C</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Diagnosis and treatment of rumination syndrome: a critical review</span>. <abbr class="cit-jnl-abbrev">Am J Gastroenterol</abbr> <span class="cit-pub-date">2019</span>;<span class="cit-vol">114</span>:<span class="cit-fpage">562</span>–<span class="cit-lpage">78</span>. <a href="http://dx.doi.org/10.14309/ajg.0000000000000060">doi:10.14309/ajg.0000000000000060</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DAm%2BJ%2BGastroenterol%26rft.volume%253D114%26rft.spage%253D562%26rft_id%253Dinfo%253Apmid%252Fhttp%253A%252F%252Fwww.n%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=http://www.n&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-19-1" title="View reference 19 in text" id="ref-19">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.19" data-doi="10.1038/ajg.2014.165"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Kessing</span> <span class="cit-name-given-names">BF</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Bredenoord</span> <span class="cit-name-given-names">AJ</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Smout</span> <span class="cit-name-given-names">A</span> </span> </li></ol><cite>. <span class="cit-article-title">The pathophysiology, diagnosis and treatment of excessive belching symptoms</span>. <abbr class="cit-jnl-abbrev">Am J Gastroenterol</abbr> <span class="cit-pub-date">2014</span>;<span class="cit-vol">109</span>:<span class="cit-fpage">1196</span>–<span class="cit-lpage">203</span>. <a href="http://dx.doi.org/10.1038/ajg.2014.165">doi:10.1038/ajg.2014.165</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DAm%2BJ%2BGastroenterol%26rft.volume%253D109%26rft.spage%253D1196%26rft_id%253Dinfo%253Adoi%252F10.1038%252Fajg.2014.165%26rft_id%253Dinfo%253Apmid%252F25001253%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1038/ajg.2014.165&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=25001253&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-20-1" title="View reference 20 in text" id="ref-20">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.20"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Chung</span> <span class="cit-name-given-names">KF</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">McGarvey</span> <span class="cit-name-given-names">L</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Song</span> <span class="cit-name-given-names">W-J</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Cough hypersensitivity and chronic cough</span>. <abbr class="cit-jnl-abbrev">Nat Rev Dis Primers</abbr> <span class="cit-pub-date">2022</span>;<span class="cit-vol">8</span>:<span class="cit-elocation-id">45</span>. <a href="http://dx.doi.org/10.1038/s41572-022-00370-w">doi:10.1038/s41572-022-00370-w</a> </cite></div><div class="cit-extra"></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-21-1" title="View reference 21 in text" id="ref-21">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.21" data-doi="10.1183/09031936.00101212"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Savarino</span> <span class="cit-name-given-names">E</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Carbone</span> <span class="cit-name-given-names">R</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Marabotto</span> <span class="cit-name-given-names">E</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Gastro-Oesophageal reflux and gastric aspiration in idiopathic pulmonary fibrosis patients</span>. <abbr class="cit-jnl-abbrev">Eur Respir J</abbr> <span class="cit-pub-date">2013</span>;<span class="cit-vol">42</span>:<span class="cit-fpage">1322</span>–<span class="cit-lpage">31</span>. <a href="http://dx.doi.org/10.1183/09031936.00101212">doi:10.1183/09031936.00101212</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DEur%2BRespir%2BJ%26rft_id%253Dinfo%253Adoi%252F10.1183%252F09031936.00101212%26rft_id%253Dinfo%253Apmid%252F23471347%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MzoiZXJqIjtzOjU6InJlc2lkIjtzOjk6IjQyLzUvMTMyMiI7czo0OiJhdG9tIjtzOjIxOiIvZ3V0am5sLzczLzIvMzYxLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-21-1" title="View reference 22 in text" id="ref-22">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.22"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Rangan</span> <span class="cit-name-given-names">V</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Borges</span> <span class="cit-name-given-names">LF</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Lo</span> <span class="cit-name-given-names">W-K</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Novel advanced impedance metrics on impedance-pH testing predict lung function decline in idiopathic pulmonary fibrosis</span>. <abbr class="cit-jnl-abbrev">Am J Gastroenterol</abbr> <span class="cit-pub-date">2022</span>;<span class="cit-vol">117</span>:<span class="cit-fpage">405</span>–<span class="cit-lpage">12</span>. <a href="http://dx.doi.org/10.14309/ajg.0000000000001577">doi:10.14309/ajg.0000000000001577</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DAm%2BJ%2BGastroenterol%26rft.volume%253D117%26rft.spage%253D405%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-23-1" title="View reference 23 in text" id="ref-23">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.23"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Zheng</span> <span class="cit-name-given-names">Z</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Luo</span> <span class="cit-name-given-names">Y</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Li</span> <span class="cit-name-given-names">J</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Randomised trials of proton pump inhibitors for gastro-oesophageal reflux disease in patients with asthma: an updated systematic review and meta-analysis</span>. <abbr class="cit-jnl-abbrev">BMJ Open</abbr> <span class="cit-pub-date">2021</span>;<span class="cit-vol">11</span>:<span class="cit-elocation-id">e043860</span>. <a href="http://dx.doi.org/10.1136/bmjopen-2020-043860">doi:10.1136/bmjopen-2020-043860</a> </cite></div><div class="cit-extra"></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-24-1" title="View reference 24 in text" id="ref-24">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.24"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Zerbib</span> <span class="cit-name-given-names">F</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Rommel</span> <span class="cit-name-given-names">N</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Pandolfino</span> <span class="cit-name-given-names">J</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Diagnosis and management of globus sensation: a clinical challenge</span>. <abbr class="cit-jnl-abbrev">Neurogastroenterol Motil</abbr> <span class="cit-pub-date">2020</span>;<span class="cit-vol">32</span>:<span class="cit-elocation-id">e13850</span>. <a href="http://dx.doi.org/10.1111/nmo.13850">doi:10.1111/nmo.13850</a> </cite></div><div class="cit-extra"></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-8-2" title="View reference 25 in text" id="ref-25">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.25" data-doi="10.1097/01.mlg.0000192173.00498.ba"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Vaezi</span> <span class="cit-name-given-names">MF</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Richter</span> <span class="cit-name-given-names">JE</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Stasney</span> <span class="cit-name-given-names">CR</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Treatment of chronic posterior laryngitis with esomeprazole</span>. <abbr class="cit-jnl-abbrev">Laryngoscope</abbr> <span class="cit-pub-date">2006</span>;<span class="cit-vol">116</span>:<span class="cit-fpage">254</span>–<span class="cit-lpage">60</span>. <a href="http://dx.doi.org/10.1097/01.mlg.0000192173.00498.ba">doi:10.1097/01.mlg.0000192173.00498.ba</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DThe%2BLaryngoscope%26rft.stitle%253DLaryngoscope%26rft.aulast%253DVaezi%26rft.auinit1%253DM.%2BF.%26rft.volume%253D116%26rft.issue%253D2%26rft.spage%253D254%26rft.epage%253D260%26rft.atitle%253DTreatment%2Bof%2Bchronic%2Bposterior%2Blaryngitis%2Bwith%2Besomeprazole.%26rft_id%253Dinfo%253Adoi%252F10.1097%252F01.mlg.0000192173.00498.ba%26rft_id%253Dinfo%253Apmid%252F16467715%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1097/01.mlg.0000192173.00498.ba&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=16467715&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=000235566100018&link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-26-1" title="View reference 26 in text" id="ref-26">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.26"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Wong</span> <span class="cit-name-given-names">M-W</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Hsiao</span> <span class="cit-name-given-names">S-H</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Wang</span> <span class="cit-name-given-names">J-H</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Esophageal hypervigilance and visceral anxiety contribute to symptom severity of laryngopharyngeal reflux</span>. <abbr class="cit-jnl-abbrev">Am J Gastroenterol</abbr> <span class="cit-pub-date">2023</span>;<span class="cit-vol">118</span>:<span class="cit-fpage">786</span>–<span class="cit-lpage">93</span>. <a href="http://dx.doi.org/10.14309/ajg.0000000000002151">doi:10.14309/ajg.0000000000002151</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DAm%2BJ%2BGastroenterol%26rft.volume%253D118%26rft.spage%253D786%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-27-1" title="View reference 27 in text" id="ref-27">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.27"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Pleyer</span> <span class="cit-name-given-names">C</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Bittner</span> <span class="cit-name-given-names">H</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Locke</span> <span class="cit-name-given-names">GR</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Overdiagnosis of gastro-esophageal reflux disease and underdiagnosis of functional dyspepsia in a USA community</span>. <abbr class="cit-jnl-abbrev">Neurogastroenterol Motil</abbr> <span class="cit-pub-date">2014</span>;<span class="cit-vol">26</span>:<span class="cit-fpage">1163</span>–<span class="cit-lpage">71</span>. <a href="http://dx.doi.org/10.1111/nmo.12377">doi:10.1111/nmo.12377</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DNeurogastroenterol%2BMotil%26rft.volume%253D26%26rft.spage%253D1163%26rft_id%253Dinfo%253Apmid%252Fhttp%253A%252F%252Fwww.n%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=http://www.n&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-28-1" title="View reference 28 in text" id="ref-28">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.28"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Visaggi</span> <span class="cit-name-given-names">P</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Del Corso</span> <span class="cit-name-given-names">G</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Gyawali</span> <span class="cit-name-given-names">CP</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Ambulatory pH-impedance findings confirm that grade B Esophagitis provides objective diagnosis of gastroesophageal reflux disease</span>. <abbr class="cit-jnl-abbrev">Am J Gastroenterol</abbr> <span class="cit-pub-date">2023</span>;<span class="cit-vol">118</span>:<span class="cit-fpage">794</span>–<span class="cit-lpage">801</span>. <a href="http://dx.doi.org/10.14309/ajg.0000000000002173">doi:10.14309/ajg.0000000000002173</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DAm%2BJ%2BGastroenterol%26rft.volume%253D118%26rft.spage%253D794%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-28-1" title="View reference 29 in text" id="ref-29">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.29" data-doi="10.1136/gutjnl-2020-323798"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Rusu</span> <span class="cit-name-given-names">R-I</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Fox</span> <span class="cit-name-given-names">MR</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Tucker</span> <span class="cit-name-given-names">E</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-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</span>. <abbr class="cit-jnl-abbrev">Gut</abbr> <span class="cit-pub-date">2021</span>;<span class="cit-vol">70</span>:<span class="cit-fpage">2230</span>–<span class="cit-lpage">7</span>. <a href="http://dx.doi.org/10.1136/gutjnl-2020-323798">doi:10.1136/gutjnl-2020-323798</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DGut%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fgutjnl-2020-323798%26rft_id%253Dinfo%253Apmid%252F33579789%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NjoiZ3V0am5sIjtzOjU6InJlc2lkIjtzOjEwOiI3MC8xMi8yMjMwIjtzOjQ6ImF0b20iO3M6MjE6Ii9ndXRqbmwvNzMvMi8zNjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-28-1" title="View reference 30 in text" id="ref-30">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.30" data-doi="10.1136/gut.45.2.172"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Lundell</span> <span class="cit-name-given-names">LR</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Dent</span> <span class="cit-name-given-names">J</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Bennett</span> <span class="cit-name-given-names">JR</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification</span>. <abbr class="cit-jnl-abbrev">Gut</abbr> <span class="cit-pub-date">1999</span>;<span class="cit-vol">45</span>:<span class="cit-fpage">172</span>–<span class="cit-lpage">80</span>. <a href="http://dx.doi.org/10.1136/gut.45.2.172">doi:10.1136/gut.45.2.172</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DGut%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fgut.45.2.172%26rft_id%253Dinfo%253Apmid%252F10403727%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NjoiZ3V0am5sIjtzOjU6InJlc2lkIjtzOjg6IjQ1LzIvMTcyIjtzOjQ6ImF0b20iO3M6MjE6Ii9ndXRqbmwvNzMvMi8zNjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-28-1" title="View reference 31 in text" id="ref-31">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.31"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Savarino</span> <span class="cit-name-given-names">E</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Zentilin</span> <span class="cit-name-given-names">P</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Frazzoni</span> <span class="cit-name-given-names">M</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Characteristics of gastro-esophageal reflux episodes in Barrett’s esophagus, erosive esophagitis and healthy volunteers</span>. <abbr class="cit-jnl-abbrev">Neurogastroenterol Motil</abbr> <span class="cit-pub-date">2010</span>;<span class="cit-vol">22</span>:<span class="cit-fpage">1061</span>–<span class="cit-lpage">e280</span>. <a href="http://dx.doi.org/10.1111/j.1365-2982.2010.01536.x">doi:10.1111/j.1365-2982.2010.01536.x</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DNeurogastroenterology%2Band%2Bmotility%2B%253A%2B%2Bthe%2Bofficial%2Bjournal%2Bof%2Bthe%2BEuropean%2BGastrointestinal%2BMotility%2BSociety%26rft.stitle%253DNeurogastroenterol%2BMotil%26rft.aulast%253DSavarino%26rft.auinit1%253DE.%26rft.volume%253D22%26rft.issue%253D10%26rft.spage%253D1061%26rft.epage%253De280%26rft.atitle%253DCharacteristics%2Bof%2Bgastro-esophageal%2Breflux%2Bepisodes%2Bin%2BBarrett%2527s%2Besophagus%252C%2Berosive%2Besophagitis%2Band%2Bhealthy%2Bvolunteers.%26rft_id%253Dinfo%253Apmid%252F20557468%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=20557468&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-30-1" title="View reference 32 in text" id="ref-32">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.32" data-doi="10.1053/gast.1996.v111.pm8698230"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Armstrong</span> <span class="cit-name-given-names">D</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Bennett</span> <span class="cit-name-given-names">JR</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Blum</span> <span class="cit-name-given-names">AL</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">The endoscopic assessment of esophagitis: a progress report on observer agreement</span>. <abbr class="cit-jnl-abbrev">Gastroenterology</abbr> <span class="cit-pub-date">1996</span>;<span class="cit-vol">111</span>:<span class="cit-fpage">85</span>–<span class="cit-lpage">92</span>. <a href="http://dx.doi.org/10.1053/gast.1996.v111.pm8698230">doi:10.1053/gast.1996.v111.pm8698230</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DGastroenterology%26rft.stitle%253DGastroenterology%26rft.aulast%253DArmstrong%26rft.auinit1%253DD%26rft.volume%253D111%26rft.issue%253D1%26rft.spage%253D85%26rft.epage%253D92%26rft.atitle%253DThe%2Bendoscopic%2Bassessment%2Bof%2Besophagitis%253A%2Ba%2Bprogress%2Breport%2Bon%2Bobserver%2Bagreement%26rft_id%253Dinfo%253Adoi%252F10.1053%252Fgast.1996.v111.pm8698230%26rft_id%253Dinfo%253Apmid%252F8698230%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1053/gast.1996.v111.pm8698230&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=8698230&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=A1996UV62200019&link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-29-1" title="View reference 33 in text" id="ref-33">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.33" data-doi="10.1159/000338849"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Takashima</span> <span class="cit-name-given-names">T</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Iwakiri</span> <span class="cit-name-given-names">R</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Sakata</span> <span class="cit-name-given-names">Y</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Endoscopic reflux esophagitis and helicobacter pylori infection in young healthy Japanese volunteers</span>. <abbr class="cit-jnl-abbrev">Digestion</abbr> <span class="cit-pub-date">2012</span>;<span class="cit-vol">86</span>:<span class="cit-fpage">55</span>–<span class="cit-lpage">8</span>. <a href="http://dx.doi.org/10.1159/000338849">doi:10.1159/000338849</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DDigestion%26rft.stitle%253DDigestion%26rft.aulast%253DTakashima%26rft.auinit1%253DT.%26rft.volume%253D86%26rft.issue%253D1%26rft.spage%253D55%26rft.epage%253D58%26rft.atitle%253DEndoscopic%2Breflux%2Besophagitis%2Band%2BHelicobacter%2Bpylori%2Binfection%2Bin%2Byoung%2Bhealthy%2BJapanese%2Bvolunteers.%26rft_id%253Dinfo%253Adoi%252F10.1159%252F000338849%26rft_id%253Dinfo%253Apmid%252F22722701%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1159/000338849&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=22722701&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-29-1" title="View reference 34 in text" id="ref-34">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.34" data-doi="10.1136/gut.2007.145177"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Zagari</span> <span class="cit-name-given-names">RM</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Fuccio</span> <span class="cit-name-given-names">L</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Wallander</span> <span class="cit-name-given-names">M-A</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Gastro-Oesophageal reflux symptoms, oesophagitis and Barrett’s oesophagus in the general population: the loiano-monghidoro study</span>. <abbr class="cit-jnl-abbrev">Gut</abbr> <span class="cit-pub-date">2008</span>;<span class="cit-vol">57</span>:<span class="cit-fpage">1354</span>–<span class="cit-lpage">9</span>. <a href="http://dx.doi.org/10.1136/gut.2007.145177">doi:10.1136/gut.2007.145177</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DGut%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fgut.2007.145177%26rft_id%253Dinfo%253Apmid%252F18424568%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NjoiZ3V0am5sIjtzOjU6InJlc2lkIjtzOjEwOiI1Ny8xMC8xMzU0IjtzOjQ6ImF0b20iO3M6MjE6Ii9ndXRqbmwvNzMvMi8zNjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-35-1" title="View reference 35 in text" id="ref-35">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.35"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Rengarajan</span> <span class="cit-name-given-names">A</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Pomarat</span> <span class="cit-name-given-names">M</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Zerbib</span> <span class="cit-name-given-names">F</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Overlap of functional Heartburn and reflux hypersensitivity with proven gastroesophageal reflux disease</span>. <abbr class="cit-jnl-abbrev">Neurogastroenterol Motil</abbr> <span class="cit-pub-date">2021</span>;<span class="cit-vol">33</span>:<span class="cit-elocation-id">e14056</span>. <a href="http://dx.doi.org/10.1111/nmo.14056">doi:10.1111/nmo.14056</a> </cite></div><div class="cit-extra"></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-36-1" title="View reference 36 in text" id="ref-36">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.36" data-doi="10.1053/gast.1997.v112.pm9178669"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Chiba</span> <span class="cit-name-given-names">N</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">De Gara</span> <span class="cit-name-given-names">CJ</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Wilkinson</span> <span class="cit-name-given-names">JM</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Speed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: a meta-analysis</span>. <abbr class="cit-jnl-abbrev">Gastroenterology</abbr> <span class="cit-pub-date">1997</span>;<span class="cit-vol">112</span>:<span class="cit-fpage">1798</span>–<span class="cit-lpage">810</span>. <a href="http://dx.doi.org/10.1053/gast.1997.v112.pm9178669">doi:10.1053/gast.1997.v112.pm9178669</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DGastroenterology%26rft.stitle%253DGastroenterology%26rft.aulast%253DChiba%26rft.auinit1%253DN%26rft.volume%253D112%26rft.issue%253D6%26rft.spage%253D1798%26rft.epage%253D1810%26rft.atitle%253DSpeed%2Bof%2Bhealing%2Band%2Bsymptom%2Brelief%2Bin%2Bgrade%2BII%2Bto%2BIV%2Bgastroesophageal%2Breflux%2Bdisease%253A%2Ba%2Bmeta-analysis%26rft_id%253Dinfo%253Adoi%252F10.1053%252Fgast.1997.v112.pm9178669%26rft_id%253Dinfo%253Apmid%252F9178669%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1053/gast.1997.v112.pm9178669&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=9178669&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=A1997XE18800008&link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-37-1" title="View reference 37 in text" id="ref-37">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.37"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Boghossian</span> <span class="cit-name-given-names">TA</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Rashid</span> <span class="cit-name-given-names">FJ</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Thompson</span> <span class="cit-name-given-names">W</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Deprescribing versus continuation of chronic proton pump inhibitor use in adults</span>. <abbr class="cit-jnl-abbrev">Cochrane Database Syst Rev</abbr> <span class="cit-pub-date">2017</span>;<span class="cit-vol">3</span>:<span class="cit-elocation-id">CD011969</span>. <a href="http://dx.doi.org/10.1002/14651858.CD011969.pub2">doi:10.1002/14651858.CD011969.pub2</a> </cite></div><div class="cit-extra"></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-38-1" title="View reference 38 in text" id="ref-38">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.38" data-doi="10.1001/jama.2016.5657"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Dunbar</span> <span class="cit-name-given-names">KB</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Agoston</span> <span class="cit-name-given-names">AT</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Odze</span> <span class="cit-name-given-names">RD</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Association of acute gastroesophageal reflux disease with esophageal histologic changes</span>. <abbr class="cit-jnl-abbrev">JAMA</abbr> <span class="cit-pub-date">2016</span>;<span class="cit-vol">315</span>:<span class="cit-fpage">2104</span>–<span class="cit-lpage">12</span>. <a href="http://dx.doi.org/10.1001/jama.2016.5657">doi:10.1001/jama.2016.5657</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DJAMA%26rft.volume%253D315%26rft.spage%253D2104%26rft_id%253Dinfo%253Adoi%252F10.1001%252Fjama.2016.5657%26rft_id%253Dinfo%253Apmid%252F27187303%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1001/jama.2016.5657&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=27187303&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-39-1" title="View reference 39 in text" id="ref-39">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.39"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Zerbib</span> <span class="cit-name-given-names">F</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Bredenoord</span> <span class="cit-name-given-names">AJ</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Fass</span> <span class="cit-name-given-names">R</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">ESNM/ANMS consensus paper: diagnosis and management of refractory gastro-esophageal reflux disease</span>. <abbr class="cit-jnl-abbrev">Neurogastroenterol Motil</abbr> <span class="cit-pub-date">2021</span>;<span class="cit-vol">33</span>:<span class="cit-elocation-id">e14075</span>. <a href="http://dx.doi.org/10.1111/nmo.14075">doi:10.1111/nmo.14075</a> </cite></div><div class="cit-extra"></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-40-1" title="View reference 40 in text" id="ref-40">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.40" data-doi="10.1111/j.1572-0241.2003.07398.x"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Pandolfino</span> <span class="cit-name-given-names">JE</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Richter</span> <span class="cit-name-given-names">JE</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Ours</span> <span class="cit-name-given-names">T</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Ambulatory esophageal pH monitoring using a wireless system</span>. <abbr class="cit-jnl-abbrev">Am J Gastroenterol</abbr> <span class="cit-pub-date">2003</span>;<span class="cit-vol">98</span>:<span class="cit-fpage">740</span>–<span class="cit-lpage">9</span>. <a href="http://dx.doi.org/10.1111/j.1572-0241.2003.07398.x">doi:10.1111/j.1572-0241.2003.07398.x</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DThe%2BAmerican%2Bjournal%2Bof%2Bgastroenterology%26rft.stitle%253DAm%2BJ%2BGastroenterol%26rft.aulast%253DPandolfino%26rft.auinit1%253DJ.%2BE.%26rft.volume%253D98%26rft.issue%253D4%26rft.spage%253D740%26rft.epage%253D749%26rft.atitle%253DAmbulatory%2Besophageal%2BpH%2Bmonitoring%2Busing%2Ba%2Bwireless%2Bsystem.%26rft_id%253Dinfo%253Adoi%252F10.1111%252Fj.1572-0241.2003.07398.x%26rft_id%253Dinfo%253Apmid%252F12738450%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1111/j.1572-0241.2003.07398.x&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=12738450&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=000182754400007&link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-40-1" title="View reference 41 in text" id="ref-41">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.41"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Yadlapati</span> <span class="cit-name-given-names">R</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Ciolino</span> <span class="cit-name-given-names">JD</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Craft</span> <span class="cit-name-given-names">J</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Trajectory assessment is useful when day-to-day esophageal acid exposure varies in prolonged wireless pH monitoring</span>. <abbr class="cit-jnl-abbrev">Dis Esophagus</abbr> <span class="cit-pub-date">2019</span>;<span class="cit-vol">32</span>:<span class="cit-elocation-id">doy077</span>. <a href="http://dx.doi.org/10.1093/dote/doy077">doi:10.1093/dote/doy077</a> </cite></div><div class="cit-extra"></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-40-1" title="View reference 42 in text" id="ref-42">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.42" data-doi="10.1053/j.gastro.2020.09.013"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Yadlapati</span> <span class="cit-name-given-names">R</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Masihi</span> <span class="cit-name-given-names">M</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Gyawali</span> <span class="cit-name-given-names">CP</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Ambulatory reflux monitoring guides proton pump inhibitor discontinuation in patients with gastroesophageal reflux symptoms: a clinical trial</span>. <abbr class="cit-jnl-abbrev">Gastroenterology</abbr> <span class="cit-pub-date">2021</span>;<span class="cit-vol">160</span>:<span class="cit-fpage">174</span>–<span class="cit-lpage">82</span>. <a href="http://dx.doi.org/10.1053/j.gastro.2020.09.013">doi:10.1053/j.gastro.2020.09.013</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DGastroenterology%26rft.volume%253D160%26rft.spage%253D174%26rft_id%253Dinfo%253Adoi%252F10.1053%252Fj.gastro.2020.09.013%26rft_id%253Dinfo%253Apmid%252Fhttp%253A%252F%252Fwww.n%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1053/j.gastro.2020.09.013&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=http://www.n&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-40-1" title="View reference 43 in text" id="ref-43">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.43" data-doi="10.5056/jnm14075"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Penagini</span> <span class="cit-name-given-names">R</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Sweis</span> <span class="cit-name-given-names">R</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Mauro</span> <span class="cit-name-given-names">A</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Inconsistency in the diagnosis of functional heartburn: usefulness of prolonged wireless pH monitoring in patients with proton pump inhibitor refractory gastroesophageal reflux disease</span>. <abbr class="cit-jnl-abbrev">J Neurogastroenterol Motil</abbr> <span class="cit-pub-date">2015</span>;<span class="cit-vol">21</span>:<span class="cit-fpage">265</span>–<span class="cit-lpage">72</span>. <a href="http://dx.doi.org/10.5056/jnm14075">doi:10.5056/jnm14075</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DJ%2BNeurogastroenterol%2BMotil%26rft.volume%253D21%26rft.spage%253D265%26rft_id%253Dinfo%253Adoi%252F10.5056%252Fjnm14075%26rft_id%253Dinfo%253Apmid%252Fhttp%253A%252F%252Fwww.n%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.5056/jnm14075&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=http://www.n&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-40-1" title="View reference 44 in text" id="ref-44">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.44" data-doi="10.1111/j.1365-2982.2010.01663.x"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Sweis</span> <span class="cit-name-given-names">R</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Fox</span> <span class="cit-name-given-names">M</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Anggiansah</span> <span class="cit-name-given-names">A</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Prolonged, Wireless pH-studies have a high diagnostic yield in patients with reflux symptoms and negative 24-H catheter-based pH-studies</span>. <abbr class="cit-jnl-abbrev">Neurogastroenterol Motil</abbr> <span class="cit-pub-date">2011</span>;<span class="cit-vol">23</span>:<span class="cit-fpage">419</span>–<span class="cit-lpage">26</span>. <a href="http://dx.doi.org/10.1111/j.1365-2982.2010.01663.x">doi:10.1111/j.1365-2982.2010.01663.x</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DNeurogastroenterology%2Band%2Bmotility%2B%253A%2B%2Bthe%2Bofficial%2Bjournal%2Bof%2Bthe%2BEuropean%2BGastrointestinal%2BMotility%2BSociety%26rft.stitle%253DNeurogastroenterol%2BMotil%26rft.aulast%253DSweis%26rft.auinit1%253DR.%26rft.volume%253D23%26rft.issue%253D5%26rft.spage%253D419%26rft.epage%253D426%26rft.atitle%253DProlonged%252C%2Bwireless%2BpH-studies%2Bhave%2Ba%2Bhigh%2Bdiagnostic%2Byield%2Bin%2Bpatients%2Bwith%2Breflux%2Bsymptoms%2Band%2Bnegative%2B24-h%2Bcatheter-based%2BpH-studies.%26rft_id%253Dinfo%253Adoi%252F10.1111%252Fj.1365-2982.2010.01663.x%26rft_id%253Dinfo%253Apmid%252F21235685%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1111/j.1365-2982.2010.01663.x&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=21235685&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-40-1" title="View reference 45 in text" id="ref-45">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.45" data-doi="10.1016/j.cgh.2020.01.031"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Hasak</span> <span class="cit-name-given-names">S</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Yadlapati</span> <span class="cit-name-given-names">R</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Altayar</span> <span class="cit-name-given-names">O</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Prolonged Wireless pH monitoring in patients with persistent reflux symptoms despite proton pump inhibitor therapy</span>. <abbr class="cit-jnl-abbrev">Clin Gastroenterol Hepatol</abbr> <span class="cit-pub-date">2020</span>;<span class="cit-vol">18</span>:<span class="cit-fpage">2912</span>–<span class="cit-lpage">9</span>. <a href="http://dx.doi.org/10.1016/j.cgh.2020.01.031">doi:10.1016/j.cgh.2020.01.031</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DClin%2BGastroenterol%2BHepatol%26rft.volume%253D18%26rft.spage%253D2912%26rft_id%253Dinfo%253Adoi%252F10.1016%252Fj.cgh.2020.01.031%26rft_id%253Dinfo%253Apmid%252Fhttp%253A%252F%252Fwww.n%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1016/j.cgh.2020.01.031&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=http://www.n&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-46-1" title="View reference 46 in text" id="ref-46">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.46" data-doi="10.14309/ajg.0000000000001871"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Yadlapati</span> <span class="cit-name-given-names">R</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Gyawali</span> <span class="cit-name-given-names">CP</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Masihi</span> <span class="cit-name-given-names">M</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Optimal Wireless reflux monitoring metrics to predict discontinuation of proton pump inhibitor therapy</span>. <abbr class="cit-jnl-abbrev">Am J Gastroenterol</abbr> <span class="cit-pub-date">2022</span>;<span class="cit-vol">117</span>:<span class="cit-fpage">1573</span>–<span class="cit-lpage">82</span>. <a href="http://dx.doi.org/10.14309/ajg.0000000000001871">doi:10.14309/ajg.0000000000001871</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DAm%2BJ%2BGastroenterol%26rft.volume%253D117%26rft.spage%253D1573%26rft_id%253Dinfo%253Adoi%252F10.14309%252Fajg.0000000000001871%26rft_id%253Dinfo%253Apmid%252F35973148%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.14309/ajg.0000000000001871&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=35973148&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-47-1" title="View reference 47 in text" id="ref-47">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.47" data-doi="10.1136/gut.2003.033290"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Sifrim</span> <span class="cit-name-given-names">D</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Castell</span> <span class="cit-name-given-names">D</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Dent</span> <span class="cit-name-given-names">J</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Gastro-Oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux</span>. <abbr class="cit-jnl-abbrev">Gut</abbr> <span class="cit-pub-date">2004</span>;<span class="cit-vol">53</span>:<span class="cit-fpage">1024</span>–<span class="cit-lpage">31</span>. <a href="http://dx.doi.org/10.1136/gut.2003.033290">doi:10.1136/gut.2003.033290</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DGut%26rft.stitle%253DGut%26rft.aulast%253DSifrim%26rft.auinit1%253DD%26rft.volume%253D53%26rft.issue%253D7%26rft.spage%253D1024%26rft.epage%253D1031%26rft.atitle%253DGastro-oesophageal%2Breflux%2Bmonitoring%253A%2Breview%2Band%2Bconsensus%2Breport%2Bon%2Bdetection%2Band%2Bdefinitions%2Bof%2Bacid%252C%2Bnon-acid%252C%2Band%2Bgas%2Breflux%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fgut.2003.033290%26rft_id%253Dinfo%253Apmid%252F15194656%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NjoiZ3V0am5sIjtzOjU6InJlc2lkIjtzOjk6IjUzLzcvMTAyNCI7czo0OiJhdG9tIjtzOjIxOiIvZ3V0am5sLzczLzIvMzYxLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-48-1" title="View reference 48 in text" id="ref-48">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.48" data-doi="10.1136/gutjnl-2020-321395"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Rogers</span> <span class="cit-name-given-names">BD</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Valdovinos</span> <span class="cit-name-given-names">LR</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Crowell</span> <span class="cit-name-given-names">MD</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-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</span>. <abbr class="cit-jnl-abbrev">Gut</abbr> <span class="cit-pub-date">2021</span>;<span class="cit-vol">70</span>:<span class="cit-fpage">450</span>–<span class="cit-lpage">5</span>. <a href="http://dx.doi.org/10.1136/gutjnl-2020-321395">doi:10.1136/gutjnl-2020-321395</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DGut%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fgutjnl-2020-321395%26rft_id%253Dinfo%253Apmid%252F32467089%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NjoiZ3V0am5sIjtzOjU6InJlc2lkIjtzOjg6IjcwLzMvNDUwIjtzOjQ6ImF0b20iO3M6MjE6Ii9ndXRqbmwvNzMvMi8zNjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-49-1" title="View reference 49 in text" id="ref-49">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.49"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Gyawali</span> <span class="cit-name-given-names">CP</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Rogers</span> <span class="cit-name-given-names">B</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Frazzoni</span> <span class="cit-name-given-names">M</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Inter-reviewer variability in interpretation of pH-impedance studies: the Wingate consensus</span>. <abbr class="cit-jnl-abbrev">Clinical Gastroenterology and Hepatology</abbr> <span class="cit-pub-date">2021</span>;<span class="cit-vol">19</span>:<span class="cit-fpage">1976</span>–<span class="cit-lpage">1978</span>. <a href="http://dx.doi.org/10.1016/j.cgh.2020.09.002">doi:10.1016/j.cgh.2020.09.002</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DClinical%2BGastroenterology%2Band%2BHepatology%26rft.volume%253D19%26rft.spage%253D1976%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-50-1" title="View reference 50 in text" id="ref-50">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.50" data-doi="10.1016/j.dld.2011.01.016"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Savarino</span> <span class="cit-name-given-names">E</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Marabotto</span> <span class="cit-name-given-names">E</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Zentilin</span> <span class="cit-name-given-names">P</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">The added value of impedance-pH monitoring to Rome III criteria in distinguishing functional Heartburn from non-erosive reflux disease</span>. <abbr class="cit-jnl-abbrev">Dig Liver Dis</abbr> <span class="cit-pub-date">2011</span>;<span class="cit-vol">43</span>:<span class="cit-fpage">542</span>–<span class="cit-lpage">7</span>. <a href="http://dx.doi.org/10.1016/j.dld.2011.01.016">doi:10.1016/j.dld.2011.01.016</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DDigestive%2Band%2Bliver%2Bdisease%2B%253A%2B%2Bofficial%2Bjournal%2Bof%2Bthe%2BItalian%2BSociety%2Bof%2BGastroenterology%2Band%2Bthe%2BItalian%2BAssociation%2Bfor%2Bthe%2BStudy%2Bof%2Bthe%2BLiver%26rft.stitle%253DDig%2BLiver%2BDis%26rft.aulast%253DSavarino%26rft.auinit1%253DE.%26rft.volume%253D43%26rft.issue%253D7%26rft.spage%253D542%26rft.epage%253D547%26rft.atitle%253DThe%2Badded%2Bvalue%2Bof%2Bimpedance-pH%2Bmonitoring%2Bto%2BRome%2BIII%2Bcriteria%2Bin%2Bdistinguishing%2Bfunctional%2Bheartburn%2Bfrom%2Bnon-erosive%2Breflux%2Bdisease.%26rft_id%253Dinfo%253Adoi%252F10.1016%252Fj.dld.2011.01.016%26rft_id%253Dinfo%253Apmid%252F21376679%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1016/j.dld.2011.01.016&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=21376679&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-50-1" title="View reference 51 in text" id="ref-51">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.51" data-doi="10.1136/gut.2007.133470"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Zerbib</span> <span class="cit-name-given-names">F</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Duriez</span> <span class="cit-name-given-names">A</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Roman</span> <span class="cit-name-given-names">S</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Determinants of gastro-oesophageal reflux perception in patients with persistent symptoms despite proton pump inhibitors</span>. <abbr class="cit-jnl-abbrev">Gut</abbr> <span class="cit-pub-date">2008</span>;<span class="cit-vol">57</span>:<span class="cit-fpage">156</span>–<span class="cit-lpage">60</span>. <a href="http://dx.doi.org/10.1136/gut.2007.133470">doi:10.1136/gut.2007.133470</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DGut%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fgut.2007.133470%26rft_id%253Dinfo%253Apmid%252F17951358%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NjoiZ3V0am5sIjtzOjU6InJlc2lkIjtzOjg6IjU3LzIvMTU2IjtzOjQ6ImF0b20iO3M6MjE6Ii9ndXRqbmwvNzMvMi8zNjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-52-1" title="View reference 52 in text" id="ref-52">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.52"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Frazzoni</span> <span class="cit-name-given-names">L</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Frazzoni</span> <span class="cit-name-given-names">M</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">de Bortoli</span> <span class="cit-name-given-names">N</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Postreflux swallow-induced peristaltic wave index and nocturnal baseline impedance can link PPI-responsive heartburn to reflux better than acid exposure time</span>. <abbr class="cit-jnl-abbrev">Neurogastroenterol Motil</abbr> <span class="cit-pub-date">2017</span>;<span class="cit-vol">29</span>:<span class="cit-fpage">11</span>. <a href="http://dx.doi.org/10.1111/nmo.13116">doi:10.1111/nmo.13116</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DNeurogastroenterol%2BMotil%26rft.volume%253D29%26rft.spage%253D11%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-52-1" title="View reference 53 in text" id="ref-53">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.53"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Frazzoni</span> <span class="cit-name-given-names">M</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Frazzoni</span> <span class="cit-name-given-names">L</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Ribolsi</span> <span class="cit-name-given-names">M</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Applying lyon consensus criteria in the work-up of patients with proton pump inhibitory-refractory heartburn</span>. <abbr class="cit-jnl-abbrev">Aliment Pharmacol Ther</abbr> <span class="cit-pub-date">2022</span>;<span class="cit-vol">55</span>:<span class="cit-fpage">1423</span>–<span class="cit-lpage">30</span>. <a href="http://dx.doi.org/10.1111/apt.16838">doi:10.1111/apt.16838</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DAliment%2BPharmacol%2BTher%26rft.volume%253D55%26rft.spage%253D1423%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-52-1" title="View reference 54 in text" id="ref-54">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.54"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Rengarajan</span> <span class="cit-name-given-names">A</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Savarino</span> <span class="cit-name-given-names">E</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Della Coletta</span> <span class="cit-name-given-names">M</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Mean nocturnal baseline impedance correlates with symptom outcome when acid exposure time is inconclusive on esophageal reflux monitoring</span>. <abbr class="cit-jnl-abbrev">Clin Gastroenterol Hepatol</abbr> <span class="cit-pub-date">2020</span>;<span class="cit-vol">18</span>:<span class="cit-fpage">589</span>–<span class="cit-lpage">95</span>. <a href="http://dx.doi.org/10.1016/j.cgh.2019.05.044">doi:10.1016/j.cgh.2019.05.044</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DClin%2BGastroenterol%2BHepatol%26rft.volume%253D18%26rft.spage%253D589%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-52-2" title="View reference 55 in text" id="ref-55">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.55"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Frazzoni</span> <span class="cit-name-given-names">M</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Bertani</span> <span class="cit-name-given-names">H</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Manta</span> <span class="cit-name-given-names">R</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Impairment of chemical clearance is relevant to the pathogenesis of refractory reflux oesophagitis</span>. <abbr class="cit-jnl-abbrev">Dig Liver Dis</abbr> <span class="cit-pub-date">2014</span>;<span class="cit-vol">46</span>:<span class="cit-fpage">596</span>–<span class="cit-lpage">602</span>. <a href="http://dx.doi.org/10.1016/j.dld.2014.03.005">doi:10.1016/j.dld.2014.03.005</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DDig%2BLiver%2BDis%26rft.volume%253D46%26rft.spage%253D596%26rft_id%253Dinfo%253Apmid%252Fhttp%253A%252F%252Fwww.n%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=http://www.n&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-52-2" title="View reference 56 in text" id="ref-56">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.56" data-doi="10.1038/s41395-018-0044-5"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Frazzoni</span> <span class="cit-name-given-names">M</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Frazzoni</span> <span class="cit-name-given-names">L</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Tolone</span> <span class="cit-name-given-names">S</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Lack of improvement of impaired chemical clearance characterizes PPI-refractory reflux-related heartburn</span>. <abbr class="cit-jnl-abbrev">Am J Gastroenterol</abbr> <span class="cit-pub-date">2018</span>;<span class="cit-vol">113</span>:<span class="cit-fpage">670</span>–<span class="cit-lpage">6</span>. <a href="http://dx.doi.org/10.1038/s41395-018-0044-5">doi:10.1038/s41395-018-0044-5</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DAm%2BJ%2BGastroenterol%26rft.volume%253D113%26rft.spage%253D670%26rft_id%253Dinfo%253Adoi%252F10.1038%252Fs41395-018-0044-5%26rft_id%253Dinfo%253Apmid%252Fhttp%253A%252F%252Fwww.n%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1038/s41395-018-0044-5&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=http://www.n&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-52-2" title="View reference 57 in text" id="ref-57">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.57"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Lo</span> <span class="cit-name-given-names">W-K</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Burakoff</span> <span class="cit-name-given-names">R</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Goldberg</span> <span class="cit-name-given-names">HJ</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Pre-transplant impedance measures of reflux are associated with early allograft injury after lung transplantation</span>. <abbr class="cit-jnl-abbrev">J Heart Lung Transplant</abbr> <span class="cit-pub-date">2015</span>;<span class="cit-vol">34</span>:<span class="cit-fpage">26</span>–<span class="cit-lpage">35</span>. <a href="http://dx.doi.org/10.1016/j.healun.2014.09.005">doi:10.1016/j.healun.2014.09.005</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DJ%2BHeart%2BLung%2BTransplant%26rft.volume%253D34%26rft.spage%253D26%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-58-1" title="View reference 58 in text" id="ref-58">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.58"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Ang</span> <span class="cit-name-given-names">D</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Ang</span> <span class="cit-name-given-names">TL</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Teo</span> <span class="cit-name-given-names">EK</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-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</span> <abbr class="cit-jnl-abbrev">J Dig Dis</abbr> <span class="cit-pub-date">2011</span>;<span class="cit-vol">12</span>:<span class="cit-fpage">341</span>–<span class="cit-lpage">8</span>. <a href="http://dx.doi.org/10.1111/j.1751-2980.2011.00519.x">doi:10.1111/j.1751-2980.2011.00519.x</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.stitle%253DJ%2BDig%2BDis%26rft.aulast%253DAng%26rft.auinit1%253DD.%26rft.volume%253D12%26rft.issue%253D5%26rft.spage%253D341%26rft.epage%253D348%26rft.atitle%253DIs%2Bimpedance%2BpH%2Bmonitoring%2Bsuperior%2Bto%2Bthe%2Bconventional%2B24-h%2BpH%2Bmeter%2Bin%2Bthe%2Bevaluation%2Bof%2Bpatients%2Bwith%2Blaryngorespiratory%2Bsymptoms%2Bsuspected%2Bto%2Bbe%2Bdue%2Bto%2Bgastroesophageal%2Breflux%2Bdisease%253F%26rft_id%253Dinfo%253Apmid%252F21955426%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=21955426&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-59-1" title="View reference 59 in text" id="ref-59">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.59" data-doi="10.1111/apt.12919"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Ribolsi</span> <span class="cit-name-given-names">M</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Savarino</span> <span class="cit-name-given-names">E</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">De Bortoli</span> <span class="cit-name-given-names">N</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Reflux pattern and role of impedance-pH variables in predicting PPI response in patients with suspected GERD-related chronic cough</span>. <abbr class="cit-jnl-abbrev">Aliment Pharmacol Ther</abbr> <span class="cit-pub-date">2014</span>;<span class="cit-vol">40</span>:<span class="cit-fpage">966</span>–<span class="cit-lpage">73</span>. <a href="http://dx.doi.org/10.1111/apt.12919">doi:10.1111/apt.12919</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DAliment%2BPharmacol%2BTher%26rft.volume%253D40%26rft.spage%253D966%26rft_id%253Dinfo%253Adoi%252F10.1111%252Fapt.12919%26rft_id%253Dinfo%253Apmid%252F25109844%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1111/apt.12919&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=25109844&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-58-2" title="View reference 60 in text" id="ref-60">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.60" data-doi="10.3748/wjg.v18.i32.4363"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">de Bortoli</span> <span class="cit-name-given-names">N</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Nacci</span> <span class="cit-name-given-names">A</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Savarino</span> <span class="cit-name-given-names">E</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related</span> <abbr class="cit-jnl-abbrev">World J Gastroenterol</abbr> <span class="cit-pub-date">2012</span>;<span class="cit-vol">18</span>:<span class="cit-fpage">4363</span>–<span class="cit-lpage">70</span>. <a href="http://dx.doi.org/10.3748/wjg.v18.i32.4363">doi:10.3748/wjg.v18.i32.4363</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DWorld%2Bjournal%2Bof%2Bgastroenterology%2B%253A%2B%2BWJG%26rft.stitle%253DWorld%2BJ%2BGastroenterol%26rft.aulast%253Dde%2BBortoli%26rft.auinit1%253DN.%26rft.volume%253D18%26rft.issue%253D32%26rft.spage%253D4363%26rft.epage%253D4370%26rft.atitle%253DHow%2Bmany%2Bcases%2Bof%2Blaryngopharyngeal%2Breflux%2Bsuspected%2Bby%2Blaryngoscopy%2Bare%2Bgastroesophageal%2Breflux%2Bdisease-related%253F%26rft_id%253Dinfo%253Adoi%252F10.3748%252Fwjg.v18.i32.4363%26rft_id%253Dinfo%253Apmid%252F22969200%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.3748/wjg.v18.i32.4363&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=22969200&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-8-3" title="View reference 61 in text" id="ref-61">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.61"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Carroll</span> <span class="cit-name-given-names">TL</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Werner</span> <span class="cit-name-given-names">A</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Nahikian</span> <span class="cit-name-given-names">K</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-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</span>. <abbr class="cit-jnl-abbrev">Laryngoscope</abbr> <span class="cit-pub-date">2017</span>;<span class="cit-vol">127 Suppl 6</span>:<span class="cit-fpage">S1</span>–<span class="cit-lpage">13</span>. <a href="http://dx.doi.org/10.1002/lary.26806">doi:10.1002/lary.26806</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DLaryngoscope%26rft.volume%253D1276%26rft.spage%253DS1%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-62-1" title="View reference 62 in text" id="ref-62">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.62"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Hemmink</span> <span class="cit-name-given-names">GJM</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Weusten</span> <span class="cit-name-given-names">BLAM</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Bredenoord</span> <span class="cit-name-given-names">AJ</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Aerophagia: excessive air swallowing demonstrated by esophageal impedance monitoring</span>. <abbr class="cit-jnl-abbrev">Clin Gastroenterol Hepatol</abbr> <span class="cit-pub-date">2009</span>;<span class="cit-vol">7</span>:<span class="cit-fpage">1127</span>–<span class="cit-lpage">9</span>. <a href="http://dx.doi.org/10.1016/j.cgh.2009.06.029">doi:10.1016/j.cgh.2009.06.029</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DClinical%2Bgastroenterology%2Band%2Bhepatology%2B%253A%2B%2Bthe%2Bofficial%2Bclinical%2Bpractice%2Bjournal%2Bof%2Bthe%2BAmerican%2BGastroenterological%2BAssociation%26rft.stitle%253DClin%2BGastroenterol%2BHepatol%26rft.aulast%253DHemmink%26rft.auinit1%253DG.%2BJ.%26rft.volume%253D7%26rft.issue%253D10%26rft.spage%253D1127%26rft.epage%253D1129%26rft.atitle%253DAerophagia%253A%2Bexcessive%2Bair%2Bswallowing%2Bdemonstrated%2Bby%2Besophageal%2Bimpedance%2Bmonitoring.%26rft_id%253Dinfo%253Apmid%252F19602452%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=19602452&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-17-2" title="View reference 63 in text" id="ref-63">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.63"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Sawada</span> <span class="cit-name-given-names">A</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Guzman</span> <span class="cit-name-given-names">M</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Nikaki</span> <span class="cit-name-given-names">K</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Identification of different phenotypes of esophageal reflux hypersensitivity and implications for treatment</span>. <abbr class="cit-jnl-abbrev">Clin Gastroenterol Hepatol</abbr> <span class="cit-pub-date">2021</span>;<span class="cit-vol">19</span>:<span class="cit-fpage">690</span>–<span class="cit-lpage">8</span>. <a href="http://dx.doi.org/10.1016/j.cgh.2020.03.063">doi:10.1016/j.cgh.2020.03.063</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DClin%2BGastroenterol%2BHepatol%26rft.volume%253D19%26rft.spage%253D690%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-64-1" title="View reference 64 in text" id="ref-64">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.64" data-doi="10.1111/j.1572-0241.2005.41210.x"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Charbel</span> <span class="cit-name-given-names">S</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Khandwala</span> <span class="cit-name-given-names">F</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Vaezi</span> <span class="cit-name-given-names">MF</span> </span> </li></ol><cite>. <span class="cit-article-title">The role of esophageal pH monitoring in symptomatic patients on PPI therapy</span>. <abbr class="cit-jnl-abbrev">Am J Gastroenterol</abbr> <span class="cit-pub-date">2005</span>;<span class="cit-vol">100</span>:<span class="cit-fpage">283</span>–<span class="cit-lpage">9</span>. <a href="http://dx.doi.org/10.1111/j.1572-0241.2005.41210.x">doi:10.1111/j.1572-0241.2005.41210.x</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DThe%2BAmerican%2Bjournal%2Bof%2Bgastroenterology%26rft.stitle%253DAm%2BJ%2BGastroenterol%26rft.aulast%253DCharbel%26rft.auinit1%253DS.%26rft.volume%253D100%26rft.issue%253D2%26rft.spage%253D283%26rft.epage%253D289%26rft.atitle%253DThe%2Brole%2Bof%2Besophageal%2BpH%2Bmonitoring%2Bin%2Bsymptomatic%2Bpatients%2Bon%2BPPI%2Btherapy.%26rft_id%253Dinfo%253Adoi%252F10.1111%252Fj.1572-0241.2005.41210.x%26rft_id%253Dinfo%253Apmid%252F15667483%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1111/j.1572-0241.2005.41210.x&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=15667483&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=000226726300006&link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-65-1" title="View reference 65 in text" id="ref-65">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.65"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Gyawali</span> <span class="cit-name-given-names">CP</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Tutuian</span> <span class="cit-name-given-names">R</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Zerbib</span> <span class="cit-name-given-names">F</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Value of pH impedance monitoring while on twice-daily proton pump inhibitor therapy to identify need for escalation of reflux management</span>. <abbr class="cit-jnl-abbrev">Gastroenterology</abbr> <span class="cit-pub-date">2021</span>;<span class="cit-vol">161</span>:<span class="cit-fpage">1412</span>–<span class="cit-lpage">22</span>. <a href="http://dx.doi.org/10.1053/j.gastro.2021.07.004">doi:10.1053/j.gastro.2021.07.004</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DGastroenterology%26rft.volume%253D161%26rft.spage%253D1412%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-66-1" title="View reference 66 in text" id="ref-66">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.66" data-doi="10.1016/j.cgh.2009.02.022"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Pritchett</span> <span class="cit-name-given-names">JM</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Aslam</span> <span class="cit-name-given-names">M</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Slaughter</span> <span class="cit-name-given-names">JC</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Efficacy of esophageal impedance/pH monitoring in patients with refractory gastroesophageal reflux disease, on and off therapy</span>. <abbr class="cit-jnl-abbrev">Clin Gastroenterol Hepatol</abbr> <span class="cit-pub-date">2009</span>;<span class="cit-vol">7</span>:<span class="cit-fpage">743</span>–<span class="cit-lpage">8</span>. <a href="http://dx.doi.org/10.1016/j.cgh.2009.02.022">doi:10.1016/j.cgh.2009.02.022</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DClinical%2Bgastroenterology%2Band%2Bhepatology%2B%253A%2B%2Bthe%2Bofficial%2Bclinical%2Bpractice%2Bjournal%2Bof%2Bthe%2BAmerican%2BGastroenterological%2BAssociation%26rft.stitle%253DClin%2BGastroenterol%2BHepatol%26rft.aulast%253DPritchett%26rft.auinit1%253DJ.%2BM.%26rft.volume%253D7%26rft.issue%253D7%26rft.spage%253D743%26rft.epage%253D748%26rft.atitle%253DEfficacy%2Bof%2Besophageal%2Bimpedance%252FpH%2Bmonitoring%2Bin%2Bpatients%2Bwith%2Brefractory%2Bgastroesophageal%2Breflux%2Bdisease%252C%2Bon%2Band%2Boff%2Btherapy.%26rft_id%253Dinfo%253Adoi%252F10.1016%252Fj.cgh.2009.02.022%26rft_id%253Dinfo%253Apmid%252F19281866%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1016/j.cgh.2009.02.022&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=19281866&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-56-1" title="View reference 67 in text" id="ref-67">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.67"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Frazzoni</span> <span class="cit-name-given-names">M</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">de Bortoli</span> <span class="cit-name-given-names">N</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Frazzoni</span> <span class="cit-name-given-names">L</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-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</span>. <abbr class="cit-jnl-abbrev">Neurogastroenterol Motil</abbr> <span class="cit-pub-date">2017</span>;<span class="cit-vol">29</span>. <a href="http://dx.doi.org/10.1111/nmo.12947">doi:10.1111/nmo.12947</a> </cite></div><div class="cit-extra"></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-56-1" title="View reference 68 in text" id="ref-68">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.68"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Frazzoni</span> <span class="cit-name-given-names">M</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Frazzoni</span> <span class="cit-name-given-names">L</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Ribolsi</span> <span class="cit-name-given-names">M</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">On-therapy impedance-pH monitoring can efficiently characterize PPI-refractory GERD and support treatment escalation</span>. <abbr class="cit-jnl-abbrev">Neurogastroenterol Motil</abbr> <span class="cit-pub-date">2023</span>;<span class="cit-vol">35</span>:<span class="cit-elocation-id">e14547</span>. <a href="http://dx.doi.org/10.1111/nmo.14547">doi:10.1111/nmo.14547</a> </cite></div><div class="cit-extra"></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-69-1" title="View reference 69 in text" id="ref-69">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.69" data-doi="10.1056/NEJMoa1811424"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Spechler</span> <span class="cit-name-given-names">SJ</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Hunter</span> <span class="cit-name-given-names">JG</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Jones</span> <span class="cit-name-given-names">KM</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Randomized trial of medical versus surgical treatment for refractory heartburn</span>. <abbr class="cit-jnl-abbrev">N Engl J Med</abbr> <span class="cit-pub-date">2019</span>;<span class="cit-vol">381</span>:<span class="cit-fpage">1513</span>–<span class="cit-lpage">23</span>. <a href="http://dx.doi.org/10.1056/NEJMoa1811424">doi:10.1056/NEJMoa1811424</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DN%2BEngl%2BJ%2BMed%26rft.volume%253D381%26rft.spage%253D1513%26rft_id%253Dinfo%253Adoi%252F10.1056%252FNEJMoa1811424%26rft_id%253Dinfo%253Apmid%252Fhttp%253A%252F%252Fwww.n%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1056/NEJMoa1811424&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=http://www.n&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-70-1" title="View reference 70 in text" id="ref-70">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.70" data-doi="10.1159/000221146"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Bajbouj</span> <span class="cit-name-given-names">M</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Becker</span> <span class="cit-name-given-names">V</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Phillip</span> <span class="cit-name-given-names">V</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">High-dose esomeprazole for treatment of symptomatic refractory gastroesophageal reflux disease--a prospective pH-Metry/impedance-controlled study</span>. <abbr class="cit-jnl-abbrev">Digestion</abbr> <span class="cit-pub-date">2009</span>;<span class="cit-vol">80</span>:<span class="cit-fpage">112</span>–<span class="cit-lpage">8</span>. <a href="http://dx.doi.org/10.1159/000221146">doi:10.1159/000221146</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DDigestion%26rft.stitle%253DDigestion%26rft.aulast%253DBajbouj%26rft.auinit1%253DM.%26rft.volume%253D80%26rft.issue%253D2%26rft.spage%253D112%26rft.epage%253D118%26rft.atitle%253DHigh-dose%2Besomeprazole%2Bfor%2Btreatment%2Bof%2Bsymptomatic%2Brefractory%2Bgastroesophageal%2Breflux%2Bdisease--a%2Bprospective%2BpH-metry%252Fimpedance-controlled%2Bstudy.%26rft_id%253Dinfo%253Adoi%252F10.1159%252F000221146%26rft_id%253Dinfo%253Apmid%252F19641320%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1159/000221146&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=19641320&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-3-2" title="View reference 71 in text" id="ref-71">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.71" data-doi="10.14309/ajg.0000000000000734"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Gyawali</span> <span class="cit-name-given-names">CP</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Carlson</span> <span class="cit-name-given-names">DA</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Chen</span> <span class="cit-name-given-names">JW</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">ACG clinical guidelines: clinical use of esophageal physiologic testing</span>. <abbr class="cit-jnl-abbrev">Am J Gastroenterol</abbr> <span class="cit-pub-date">2020</span>;<span class="cit-vol">115</span>:<span class="cit-fpage">1412</span>–<span class="cit-lpage">28</span>. <a href="http://dx.doi.org/10.14309/ajg.0000000000000734">doi:10.14309/ajg.0000000000000734</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DAm%2BJ%2BGastroenterol%26rft.volume%253D115%26rft.spage%253D1412%26rft_id%253Dinfo%253Adoi%252F10.14309%252Fajg.0000000000000734%26rft_id%253Dinfo%253Apmid%252Fhttp%253A%252F%252Fwww.n%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.14309/ajg.0000000000000734&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=http://www.n&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-72-1" title="View reference 72 in text" id="ref-72">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.72"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Aziz</span> <span class="cit-name-given-names">Q</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Fass</span> <span class="cit-name-given-names">R</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Gyawali</span> <span class="cit-name-given-names">CP</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Esophageal disorders</span>. <abbr class="cit-jnl-abbrev">Gastroenterology</abbr> <span class="cit-pub-date">2016</span>;<span class="cit-vol">150</span>:<span class="cit-fpage">1368</span>–<span class="cit-lpage">79</span>. <a href="http://dx.doi.org/10.1053/j.gastro.2016.02.012">doi:10.1053/j.gastro.2016.02.012</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DGastroenterology%26rft.volume%253D150%26rft.issue%253D6%26rft.spage%253D1368%26rft.atitle%253DESOPHAGEAL%2BDISORDERS%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-73-1" title="View reference 73 in text" id="ref-73">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.73" data-doi="10.1016/j.cgh.2011.07.009"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Slaughter</span> <span class="cit-name-given-names">JC</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Goutte</span> <span class="cit-name-given-names">M</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Rymer</span> <span class="cit-name-given-names">JA</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Caution about overinterpretation of symptom indexes in reflux monitoring for refractory gastroesophageal reflux disease</span>. <abbr class="cit-jnl-abbrev">Clin Gastroenterol Hepatol</abbr> <span class="cit-pub-date">2011</span>;<span class="cit-vol">9</span>:<span class="cit-fpage">868</span>–<span class="cit-lpage">74</span>. <a href="http://dx.doi.org/10.1016/j.cgh.2011.07.009">doi:10.1016/j.cgh.2011.07.009</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DClinical%2Bgastroenterology%2Band%2Bhepatology%2B%253A%2B%2Bthe%2Bofficial%2Bclinical%2Bpractice%2Bjournal%2Bof%2Bthe%2BAmerican%2BGastroenterological%2BAssociation%26rft.stitle%253DClin%2BGastroenterol%2BHepatol%26rft.aulast%253DSlaughter%26rft.auinit1%253DJ.%2BC.%26rft.volume%253D9%26rft.issue%253D10%26rft.spage%253D868%26rft.epage%253D874%26rft.atitle%253DCaution%2Babout%2Boverinterpretation%2Bof%2Bsymptom%2Bindexes%2Bin%2Breflux%2Bmonitoring%2Bfor%2Brefractory%2Bgastroesophageal%2Breflux%2Bdisease.%26rft_id%253Dinfo%253Adoi%252F10.1016%252Fj.cgh.2011.07.009%26rft_id%253Dinfo%253Apmid%252F21782769%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1016/j.cgh.2011.07.009&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=21782769&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-1-5" title="View reference 74 in text" id="ref-74">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.74" data-doi="10.1007/BF01535789"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Wiener</span> <span class="cit-name-given-names">GJ</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Morgan</span> <span class="cit-name-given-names">TM</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Copper</span> <span class="cit-name-given-names">JB</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Ambulatory 24-hour esophageal pH monitoring. reproducibility and variability of pH parameters</span>. <abbr class="cit-jnl-abbrev">Dig Dis Sci</abbr> <span class="cit-pub-date">1988</span>;<span class="cit-vol">33</span>:<span class="cit-fpage">1127</span>–<span class="cit-lpage">33</span>. <a href="http://dx.doi.org/10.1007/BF01535789">doi:10.1007/BF01535789</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DDigestive%2Bdiseases%2Band%2Bsciences%26rft.stitle%253DDig%2BDis%2BSci%26rft.aulast%253DWiener%26rft.auinit1%253DG.%2BJ.%26rft.volume%253D33%26rft.issue%253D9%26rft.spage%253D1127%26rft.epage%253D1133%26rft.atitle%253DAmbulatory%2B24-hour%2Besophageal%2BpH%2Bmonitoring.%2BReproducibility%2Band%2Bvariability%2Bof%2BpH%2Bparameters.%26rft_id%253Dinfo%253Adoi%252F10.1007%252FBF01535789%26rft_id%253Dinfo%253Apmid%252F3044715%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1007/BF01535789&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=3044715&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=A1988P988300012&link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-75-1" title="View reference 75 in text" id="ref-75">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.75"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Sifrim</span> <span class="cit-name-given-names">D</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Roman</span> <span class="cit-name-given-names">S</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Savarino</span> <span class="cit-name-given-names">E</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Normal values and regional differences in Oesophageal impedance-pH Metrics: a consensus analysis of impedance-pH studies from around the world</span>. <abbr class="cit-jnl-abbrev">Gut</abbr> <span class="cit-pub-date">2020</span>:<span class="cit-elocation-id">gutjnl-2020-322627</span>. <a href="http://dx.doi.org/10.1136/gutjnl-2020-322627">doi:10.1136/gutjnl-2020-322627</a> </cite></div><div class="cit-extra"></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-76-1" title="View reference 76 in text" id="ref-76">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.76"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Nikolic</span> <span class="cit-name-given-names">M</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Matic</span> <span class="cit-name-given-names">A</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Feka</span> <span class="cit-name-given-names">J</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Expanded indication for magnetic sphincter augmentation: outcomes in weakly acidic reflux compared to standard GERD patients</span>. <abbr class="cit-jnl-abbrev">J Gastrointest Surg</abbr> <span class="cit-pub-date">2022</span>;<span class="cit-vol">26</span>:<span class="cit-fpage">532</span>–<span class="cit-lpage">41</span>. <a href="http://dx.doi.org/10.1007/s11605-021-05152-5">doi:10.1007/s11605-021-05152-5</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DJ%2BGastrointest%2BSurg%26rft.volume%253D26%26rft.spage%253D532%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-77-1" title="View reference 77 in text" id="ref-77">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.77"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Horton</span> <span class="cit-name-given-names">AJ</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Clayton</span> <span class="cit-name-given-names">SB</span> </span> </li></ol><cite>. <span class="cit-article-title">Optimization of impedance-measured reflux events in GORD utilizing acid exposure time</span>. <abbr class="cit-jnl-abbrev">BMC Gastroenterol</abbr> <span class="cit-pub-date">2020</span>;<span class="cit-vol">20</span>:<span class="cit-elocation-id">179</span>. <a href="http://dx.doi.org/10.1186/s12876-020-01321-z">doi:10.1186/s12876-020-01321-z</a> </cite></div><div class="cit-extra"></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-78-1" title="View reference 78 in text" id="ref-78">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.78" data-doi="10.1111/nmo.12299"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Martinucci</span> <span class="cit-name-given-names">I</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">de Bortoli</span> <span class="cit-name-given-names">N</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Savarino</span> <span class="cit-name-given-names">E</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Esophageal baseline impedance levels in patients with pathophysiological characteristics of functional heartburn</span>. <abbr class="cit-jnl-abbrev">Neurogastroenterol Motil</abbr> <span class="cit-pub-date">2014</span>;<span class="cit-vol">26</span>:<span class="cit-fpage">546</span>–<span class="cit-lpage">55</span>. <a href="http://dx.doi.org/10.1111/nmo.12299">doi:10.1111/nmo.12299</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DNeurogastroenterol%2BMotil%26rft.volume%253D26%26rft.spage%253D546%26rft_id%253Dinfo%253Adoi%252F10.1111%252Fnmo.12299%26rft_id%253Dinfo%253Apmid%252Fhttp%253A%252F%252Fwww.n%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1111/nmo.12299&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=http://www.n&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-79-1" title="View reference 79 in text" id="ref-79">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.79"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Hoshikawa</span> <span class="cit-name-given-names">Y</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Sawada</span> <span class="cit-name-given-names">A</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Sonmez</span> <span class="cit-name-given-names">S</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Measurement of esophageal nocturnal baseline impedance: a simplified method</span>. <abbr class="cit-jnl-abbrev">J Neurogastroenterol Motil</abbr> <span class="cit-pub-date">2020</span>;<span class="cit-vol">26</span>:<span class="cit-fpage">241</span>–<span class="cit-lpage">7</span>. <a href="http://dx.doi.org/10.5056/jnm19183">doi:10.5056/jnm19183</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DJ%2BNeurogastroenterol%2BMotil%26rft.volume%253D26%26rft.spage%253D241%26rft_id%253Dinfo%253Apmid%252Fhttp%253A%252F%252Fwww.n%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=http://www.n&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-80-1" title="View reference 80 in text" id="ref-80">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.80" data-doi="10.1136/gutjnl-2021-325531"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Frazzoni</span> <span class="cit-name-given-names">L</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Frazzoni</span> <span class="cit-name-given-names">M</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">De Bortoli</span> <span class="cit-name-given-names">N</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Application of lyon consensus criteria for GORD diagnosis: evaluation of conventional and new impedance-pH parameters</span>. <abbr class="cit-jnl-abbrev">Gut</abbr> <span class="cit-pub-date">2022</span>;<span class="cit-vol">71</span>:<span class="cit-fpage">1062</span>–<span class="cit-lpage">7</span>. <a href="http://dx.doi.org/10.1136/gutjnl-2021-325531">doi:10.1136/gutjnl-2021-325531</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DGut%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fgutjnl-2021-325531%26rft_id%253Dinfo%253Apmid%252F34376517%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NjoiZ3V0am5sIjtzOjU6InJlc2lkIjtzOjk6IjcxLzYvMTA2MiI7czo0OiJhdG9tIjtzOjIxOiIvZ3V0am5sLzczLzIvMzYxLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-81-1" title="View reference 81 in text" id="ref-81">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.81" data-doi="10.1007/s00535-012-0672-2"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Savarino</span> <span class="cit-name-given-names">E</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Zentilin</span> <span class="cit-name-given-names">P</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Mastracci</span> <span class="cit-name-given-names">L</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Microscopic esophagitis distinguishes patients with non-erosive reflux disease from those with functional heartburn</span>. <abbr class="cit-jnl-abbrev">J Gastroenterol</abbr> <span class="cit-pub-date">2013</span>;<span class="cit-vol">48</span>:<span class="cit-fpage">473</span>–<span class="cit-lpage">82</span>. <a href="http://dx.doi.org/10.1007/s00535-012-0672-2">doi:10.1007/s00535-012-0672-2</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DJ%2BGastroenterol%26rft.volume%253D48%26rft.spage%253D473%26rft_id%253Dinfo%253Adoi%252F10.1007%252Fs00535-012-0672-2%26rft_id%253Dinfo%253Apmid%252F23001252%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1007/s00535-012-0672-2&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=23001252&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-82-1" title="View reference 82 in text" id="ref-82">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.82" data-doi="10.1038/ajg.2010.476"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Vela</span> <span class="cit-name-given-names">MF</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Craft</span> <span class="cit-name-given-names">BM</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Sharma</span> <span class="cit-name-given-names">N</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Refractory heartburn: comparison of Intercellular space diameter in documented GERD vs. functional heartburn</span>. <abbr class="cit-jnl-abbrev">Am J Gastroenterol</abbr> <span class="cit-pub-date">2011</span>;<span class="cit-vol">106</span>:<span class="cit-fpage">844</span>–<span class="cit-lpage">50</span>. <a href="http://dx.doi.org/10.1038/ajg.2010.476">doi:10.1038/ajg.2010.476</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DThe%2BAmerican%2Bjournal%2Bof%2Bgastroenterology%26rft.stitle%253DAm%2BJ%2BGastroenterol%26rft.aulast%253DVela%26rft.auinit1%253DM.%2BF.%26rft.volume%253D106%26rft.issue%253D5%26rft.spage%253D844%26rft.epage%253D850%26rft.atitle%253DRefractory%2Bheartburn%253A%2Bcomparison%2Bof%2Bintercellular%2Bspace%2Bdiameter%2Bin%2Bdocumented%2BGERD%2Bvs.%2Bfunctional%2Bheartburn.%26rft_id%253Dinfo%253Adoi%252F10.1038%252Fajg.2010.476%26rft_id%253Dinfo%253Apmid%252F21179012%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1038/ajg.2010.476&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=21179012&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-39-3" title="View reference 83 in text" id="ref-83">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.83" data-doi="10.1016/j.bpg.2013.06.010"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Krugmann</span> <span class="cit-name-given-names">J</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Neumann</span> <span class="cit-name-given-names">H</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Vieth</span> <span class="cit-name-given-names">M</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">What is the role of endoscopy and oesophageal biopsies in the management of GERD?</span> <abbr class="cit-jnl-abbrev">Best Pract Res Clin Gastroenterol</abbr> <span class="cit-pub-date">2013</span>;<span class="cit-vol">27</span>:<span class="cit-fpage">373</span>–<span class="cit-lpage">85</span>. <a href="http://dx.doi.org/10.1016/j.bpg.2013.06.010">doi:10.1016/j.bpg.2013.06.010</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DBest%2BPract%2BRes%2BClin%2BGastroenterol%26rft.volume%253D27%26rft.spage%253D373%26rft_id%253Dinfo%253Adoi%252F10.1016%252Fj.bpg.2013.06.010%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1016/j.bpg.2013.06.010&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-84-1" title="View reference 84 in text" id="ref-84">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.84"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Oude Nijhuis</span> <span class="cit-name-given-names">RAB</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Curvers</span> <span class="cit-name-given-names">WL</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">van der Ende</span> <span class="cit-name-given-names">M</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Utility of routine esophageal biopsies in patients with refractory reflux symptoms</span>. <abbr class="cit-jnl-abbrev">Am J Gastroenterol</abbr> <span class="cit-pub-date">2021</span>;<span class="cit-vol">116</span>:<span class="cit-fpage">816</span>–<span class="cit-lpage">20</span>. <a href="http://dx.doi.org/10.14309/ajg.0000000000001064">doi:10.14309/ajg.0000000000001064</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DAm%2BJ%2BGastroenterol%26rft.volume%253D116%26rft.spage%253D816%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-85-1" title="View reference 85 in text" id="ref-85">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.85"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Ates</span> <span class="cit-name-given-names">F</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Yuksel</span> <span class="cit-name-given-names">ES</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Higginbotham</span> <span class="cit-name-given-names">T</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Mucosal impedance discriminates GERD from non-GERD conditions</span>. <abbr class="cit-jnl-abbrev">Gastroenterology</abbr> <span class="cit-pub-date">2015</span>;<span class="cit-vol">148</span>:<span class="cit-fpage">334</span>–<span class="cit-lpage">43</span>. <a href="http://dx.doi.org/10.1053/j.gastro.2014.10.010">doi:10.1053/j.gastro.2014.10.010</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DGastroenterology%26rft.volume%253D148%26rft.spage%253D334%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-85-1" title="View reference 86 in text" id="ref-86">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.86" data-doi="10.1016/j.cgh.2012.05.018"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Saritas Yuksel</span> <span class="cit-name-given-names">E</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Higginbotham</span> <span class="cit-name-given-names">T</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Slaughter</span> <span class="cit-name-given-names">JC</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Use of direct, endoscopic-guided measurements of mucosal impedance in diagnosis of gastroesophageal reflux disease</span>. <abbr class="cit-jnl-abbrev">Clin Gastroenterol Hepatol</abbr> <span class="cit-pub-date">2012</span>;<span class="cit-vol">10</span>:<span class="cit-fpage">1110</span>–<span class="cit-lpage">6</span>. <a href="http://dx.doi.org/10.1016/j.cgh.2012.05.018">doi:10.1016/j.cgh.2012.05.018</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DClinical%2Bgastroenterology%2Band%2Bhepatology%2B%253A%2B%2Bthe%2Bofficial%2Bclinical%2Bpractice%2Bjournal%2Bof%2Bthe%2BAmerican%2BGastroenterological%2BAssociation%26rft.stitle%253DClin%2BGastroenterol%2BHepatol%26rft.aulast%253DYuksel%26rft.auinit1%253DE.%2BS.%26rft.volume%253D10%26rft.issue%253D10%26rft.spage%253D1110%26rft.epage%253D1116%26rft.atitle%253DUse%2Bof%2Bdirect%252C%2Bendoscopic-guided%2Bmeasurements%2Bof%2Bmucosal%2Bimpedance%2Bin%2Bdiagnosis%2Bof%2Bgastroesophageal%2Breflux%2Bdisease.%26rft_id%253Dinfo%253Adoi%252F10.1016%252Fj.cgh.2012.05.018%26rft_id%253Dinfo%253Apmid%252F22642956%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1016/j.cgh.2012.05.018&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=22642956&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-87-1" title="View reference 87 in text" id="ref-87">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.87"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Chan</span> <span class="cit-name-given-names">WW</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Haroian</span> <span class="cit-name-given-names">LR</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Gyawali</span> <span class="cit-name-given-names">CP</span> </span> </li></ol><cite>. <span class="cit-article-title">Value of preoperative esophageal function studies before Laparoscopic Antireflux surgery</span>. <abbr class="cit-jnl-abbrev">Surg Endosc</abbr> <span class="cit-pub-date">2011</span>;<span class="cit-vol">25</span>:<span class="cit-fpage">2943</span>–<span class="cit-lpage">9</span>. <a href="http://dx.doi.org/10.1007/s00464-011-1646-9">doi:10.1007/s00464-011-1646-9</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DSurgical%2Bendoscopy%26rft.stitle%253DSurg%2BEndosc%26rft.aulast%253DChan%26rft.auinit1%253DW.%2BW.%26rft.volume%253D25%26rft.issue%253D9%26rft.spage%253D2943%26rft.epage%253D2949%26rft.atitle%253DValue%2Bof%2Bpreoperative%2Besophageal%2Bfunction%2Bstudies%2Bbefore%2Blaparoscopic%2Bantireflux%2Bsurgery.%26rft_id%253Dinfo%253Apmid%252F21424193%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=21424193&link_type=MED&atom=%2Fgutjnl%2F73%2F2%2F361.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-88-1" title="View reference 88 in text" id="ref-88">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.88"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Rogers</span> <span class="cit-name-given-names">BD</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Rengarajan</span> <span class="cit-name-given-names">A</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Mauro</span> <span class="cit-name-given-names">A</span> </span>, <span class="cit-etal">et al</span> </li></ol><cite>. <span class="cit-article-title">Fragmented and failed swallows on esophageal high-resolution manometry associate with abnormal reflux burden better than weak swallows</span>. <abbr class="cit-jnl-abbrev">Neurogastroenterol Motil</abbr> <span class="cit-pub-date">2020</span>;<span class="cit-vol">32</span>:<span class="cit-elocation-id">e13736</span>. <a href="http://dx.doi.org/10.1111/nmo.13736">doi:10.1111/nmo.13736</a> </cite></div><div class="cit-extra"></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-88-1" title="View reference 89 in text" id="ref-89">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.89"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Rengarajan</span> <span class="cit-name-given-names">A</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Gyawali</span> <span class="cit-name-given-names">CP</span> </span> </li></ol><cite>. <span class="cit-article-title">High-resolution manometry can characterize esophagogastric junction morphology and predict esophageal reflux burden</span>. <abbr class="cit-jnl-abbrev">J Clin Gastroenterol</abbr> <span class="cit-pub-date">2020</span>;<span class="cit-vol">54</span>:<span class="cit-fpage">22</span>–<span class="cit-lpage">7</span>. <a href="http://dx.doi.org/10.1097/MCG.0000000000001205">doi:10.1097/MCG.0000000000001205</a> </cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DJ%2BClin%2BGastroenterol%26rft.volume%253D54%26rft.spage%253D22%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-88-1" title="View reference 90 in text" id="ref-90">↵</a><div class="cit ref-cit ref-journal" id="cit-73.2.361.90"><div class="cit-metadata"><ol class="cit-auth-list"><li> </li><li><span class="cit-auth"> <span class="cit-name-surname">Jain</span> <span class="cit-name-given-names">A</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Baker</span> <span class="cit-name-given-names">JR</span> </span>, </li><li><span class="cit-auth"> <span class="cit-name-surname">Chen</span> <span class="cit-name-given-names">JW</span> </span> </li></ol><cite>. <span class="cit-article-title">In ineffective esophageal motility, failed swallows are more functionally relevant than weak swallows</span>. <abbr class="cit-jnl-abbrev">Neurogastroenterol Motil</abbr> <span class="cit-pub-date">2018</span>;<span class="cit-vol">30</span>:<span class="cit-elocation-id">e13297</span>. <a href="http://dx.doi.org/10.1111/nmo.13297">doi:10.1111/nmo.13297</a> </cite></div><div class="cit-extra"></div></div></li></ol></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-bmjj-learning-test mobile-hidden col-narrow-12" > <div class="pane-content"> <p class="learning-link hidden-xs"><a href="/external-ref?id=10.1136/gutjnl-2023-330616" target="_blank"><img src="/sites/default/modules/jnl_template_bmjj/plugins/content_types/images//logo-learning-take-the-test.png" alt="BMJ Learning - Take the Test"></a></p> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-markup footnotes" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-other" id="fn-4"><p id="p-53"><span class="fn-label">Correction notice</span> This article has been corrected since it published Online First. Formatting issues have been corrected and a value in table 2 updated.</p></li><li class="fn-other" id="fn-5"><p id="p-54"><span class="fn-label">Contributors</span> Guarantor of the manuscript: CPG. The steering committee (CPG, JP, ES, DS, SR and FZ) identified key areas in need of update. The core group (CPG, RF, DK, JP, ES, DS, SS, SR, RY and FZ) developed statements and supporting literature. MRF (non-voting member) reviewed the statements and supporting literature for accuracy. RY created the voting platform and compiled the votes. The remaining 20 authors of the core and working groups refined and voted on the statements. All authors contributed to the content of the manuscript, and reviewed, edited and approved the final draft.</p></li><li class="fn-other" id="fn-6"><p id="p-55"><span class="fn-label">Funding</span> The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.</p></li><li class="fn-conflict" id="fn-7"><p id="p-56"><span class="fn-label">Competing interests</span> CPG: Medtronic, Diversatek (consulting), Carnot (speaker); RY: Consultant: Phathom, RJS Mediagnostix, Reckitt. Research Support: Ironwood. Consultant through Institutional Agreement: Medtronic, StatLink; RF: Advisor—Takeda, Medtronic, Phathom pharmaceuticals, GERDCare, Celexio, Johnson&Johnson, Carnot, Veritas. Speaker—Astrazeneca, Takeda, Laborie, Eisai, Johnson&Johnson, Medicamenta, Adcock-Ingram, Carnot; DK: Consulting for Sanofi/Regeneron, Research advisor, Medtronic; JP: Medtronic, Diversatek (consulting); ES: Speaker for Abbvie, Agave, AGPharma, Alfasigma, Aurora Pharma, CaDiGroup, Celltrion, Dr Falk, EG Stada Group, Fenix Pharma, Fresenius Kabi, Galapagos, Janssen, JB Pharmaceuticals, Innovamedica/Adacyte, Malesci, Mayoly Biohealth, Omega Pharma, Pfizer, Reckitt Benckiser, Sandoz, SILA, Sofar, Takeda, Tillots, Unifarco; has served as consultant for Abbvie, Agave, Alfasigma, Biogen, Bristol-Myers Squibb, Celltrion, Diadema Farmaceutici, Dr. Falk, Fenix Pharma, Fresenius Kabi, Janssen, JB Pharmaceuticals, Merck & Co, Reckitt Benckiser, Regeneron, Sanofi, SILA, Sofar, Synformulas, Takeda, Unifarco; research support from Pfizer, Reckitt Benckiser, SILA, Sofar, Unifarco, Zeta Farmaceutici; DS: Reckkit Benkiser, UK, Jinshang China (honorarium, research grants); SS: Consultant for Phathom Pharmaceuticals, Ironwood Pharmaceuticals, ISOThrive, Castle Biosciences; FZ: Dr Falk Pharma, Sanofi, Astra Zeneca, Janssen, Bioproje; MRF: Medtronic, Diversatek, Laborie, Reckitt, Mui Scientific, Weleda, Schwabe; SB: none; NdB: speaker for: Reckitt-Benkiser, Malesci, Sofar, Dr Falk. Advisory Board: Astra-Zeneca; YKC: none; DC: none; C-LC: none; CC: none; AH: none; JMRT: Advisory Board for Astra Zeneca, Medtronic, Carnot, Chinoin, Medix and Biocox; YX: none; MFV: Advisory Board: Ironwood, Phathom, Isothrive, Sanofi, Bethanamist, Ellodi, Cinclus; Patent-co-owner of patent on mucosal integrity technology along with Vanderbilt University; Legal-Consultant in litigation relating to acid suppressive therapy; SR: Medtronic, Sanofi, Dr Falk Pharma.</p></li><li class="fn-other" id="fn-8"><p id="p-57"><span class="fn-label">Provenance and peer review</span> Not commissioned; externally peer reviewed.</p></li></ul></div></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-4" > <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" 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-pXN5XOfGemPQiyDwQ9acPSKXDVI8B6-v58uQt77jGvs" /> <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" 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 © 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__IJuO2zTBevR9UaeFd_maXXn3NHFQrDb_xzKCcbFnGYo__-vovmN1y_fWj5zBzIJmQpOeve1aT7OKOuvKs0lJqP1Y__RBpwsggTa-66iCd391Lg7-ZmaIvHPOUAGYyVtdCScb8.js"></script> <script type="text/javascript" src="/sites/default/files/advagg_js/js__2WRbxlwOW0MEUc_hSWU5MBepQg6Lch6O5SZwefpJ6IE__HCL0YQJqLkOhrLPZZYGqosGvtFsEHMGghHIkSx4y9vA__RBpwsggTa-66iCd391Lg7-ZmaIvHPOUAGYyVtdCScb8.js" defer="defer"></script> <script type="text/javascript" src="/sites/default/files/advagg_js/js__TNsYypkKctiRBAVMXIC0LyA-0lgblrXCPS2SWj3c5Yg__GHeqgMA_vUCm5OpbvBn_n1XMejgj_KvhKwJFqwXAILY__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__3YMnGGenZXx95e2d4w4qdZ8l2Nb4ScWnb6eRd_RG1Rk__bLDjtRazOW5NHwJqxd6XFtHApU0Yj0Keahi0hcnwqJ4__RBpwsggTa-66iCd391Lg7-ZmaIvHPOUAGYyVtdCScb8.js"></script> </body> </html>