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. 2022 Jun;55(11):1423-1430.
doi: 10.1111/apt.16838. Epub 2022 Feb 28.

Applying Lyon Consensus criteria in the work-up of patients with proton pump inhibitory-refractory heartburn

Marzio Frazzoni  1 , Leonardo Frazzoni  2 , Mentore Ribolsi  3 , Nicola De Bortoli  4 , Salvatore Tolone  5 , Salvatore Russo  6 , Rita Conigliaro  6 , Roberto Penagini  7 , Lorenzo Fuccio  2 , Rocco Maurizio Zagari  2 , Edoardo Savarino  8
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Applying Lyon Consensus criteria in the work-up of patients with proton pump inhibitory-refractory heartburn

Marzio Frazzoni et al. Aliment Pharmacol Ther. 2022 Jun.

Abstract

Background: A hierarchical approach for gastro-oesophageal reflux disease (GERD) diagnosis by impedance-pH monitoring was proposed by the Lyon Consensus, based on acid exposure time (AET) and supportive impedance metrics.

Aims: To establish the clinical value of Lyon Consensus criteria in the work-up of patients with proton pump inhibitory (PPI)-refractory heartburn.

Methods: Expert review of off-therapy impedance-pH tracings from unproven GERD patients with PPI-refractory heartburn prospectively evaluated at referral centers. Impedance metrics, namely total reflux episodes, postreflux swallow-induced peristaltic wave index, and mean nocturnal baseline impedance, were assessed. Expert review of on-therapy preoperative impedance-pH tracings from a separate cohort of surgically treated erosive/nonerosive GERD cases.

Results: Off-therapy, normal, inconclusive, and abnormal AET was found in 59%, 17%, and 23% of 317 cases. Supportive evidence of GERD was provided by abnormal impedance metrics in up to 22% and 62% of cases in the normal and inconclusive AET groups, respectively. Adding the cases with inconclusive AET and abnormal impedance metrics to the abnormal AET group, a significant increase in GERD evidence was observed (from 23% to 37% of cases, p < 0.0002). At the on-therapy presurgical evaluation, abnormal/inconclusive AET and supraphysiological values of impedance metrics showed ongoing reflux in 21% and 90% of 96 cases, respectively (p < 0.00001); a relationship between on-therapy ongoing reflux and PPI-refractory heartburn was confirmed by the favorable surgical outcome at 3-year follow-up, 88% of cases being in persistent off-PPI heartburn remission.

Conclusions: Impedance-pH monitoring, off- and on-therapy, is of high clinical value in the work-up of patients with PPI-refractory heartburn.

Keywords: GERD; PPI; impedance-pH monitoring; laparoscopic fundoplication.

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References

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