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Multicenter Study
. 2025 Oct;62(7):710-721.
doi: 10.1111/apt.70245. Epub 2025 Jun 20.

Combined Lyon and Milan Scores Predict Gerd Management Outcome Better Than Either Score Alone or Their Individual Components

Stefano Siboni  1 , Marco Sozzi  1 , Pierfrancesco Visaggi  2 , Sara Boveri  3 , Benjamin D Rogers  4   5 , Nicola De Bortoli  2 , Anthony Hobson  6 , Brian E Louie  7 , Yeong Yeh Lee  8 , Salvatore Tolone  9 , Elisa Marabotto  10 , Jordan Haworth  6 , Megan L Ivy  7 , Lorenzo Cusmai  1 , Edoardo Campioli  1 , Dimitrios Theodorou  11 , Tania Triantafyllou  11 , Andrea Pasta  10 , Francesco Calabrese  10 , Vincent Tee  8 , Daniele Bernardi  1 , Carlo Galdino Riva  1 , Roberta De Maron  1 , Enrique Coss-Adame  12 , Amit Patel  13 , Emanuele Asti  1 , Edoardo Savarino  14 , C Prakash Gyawali  3
Affiliations
Multicenter Study

Combined Lyon and Milan Scores Predict Gerd Management Outcome Better Than Either Score Alone or Their Individual Components

Stefano Siboni et al. Aliment Pharmacol Ther. 2025 Oct.

Abstract

Background: Confidence in gastro-oesophageal reflux disease (GERD) diagnosis is crucial to improve outcomes from escalation of treatment. The Lyon score phenotypes patients through endoscopy and pH-impedance (MII-pH). The Milan score quantifies antireflux barrier through high-resolution manometry (HRM) parameters.

Aim: To explore the relationship between the Lyon and Milan scores and their combined performance in predicting clinical outcomes.

Methods: We collected clinical and follow-up data of consecutive patients with HRM and MII-pH from nine centres. Clinical improvement was defined as a 50% reduction in global symptoms. The relationship between Lyon and Milan scores and the rate of patients improved in Lyon phenotypes and Milan categories were explored. The ability of the Lyon, Milan, DeMeester scores and acid exposure time (AET) in predicting outcomes was assessed through receiver operating characteristics (ROC) analysis.

Results: Among 532 patients (50.6% female, age 50 years), 47.7% had pathologic GERD. A stepwise increase in the Milan score in Lyon phenotypes was observed. Sixty-three patients had surgical treatment, and 131 medical. Clinical improvement in Lyon phenotypes Conclusive and Severe was 81% and 83%; in Milan categories very likely and extremely likely was 88.5% and 100%. If Lyon and Milan scores were positive, improvement was 89%; if discordant, 63%; if both negative, 19% (p < 0.001). ROC analysis showed an AUC of 0.790 for Lyon score, 0.835 for Milan score, 0.736 for DeMeester score and 0.741 for AET.

Conclusions: The Lyon and Milan scores outperformed AET and DeMeester scores in predicting outcomes in GERD patients. When concordant, they provide optimal predictive accuracy, guiding escalation of therapy.

Keywords: gastro‐oesophageal reflux disease; high‐resolution manometry; reflux monitoring.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Calculation of the Milan score (A), Milan score categories (B), calculation of the Lyon score (C) and Lyon score phenotypes (D).
FIGURE 2
FIGURE 2
Proportion of patients with clinical improvement according to the concordance between Milan and Lyon scores.
FIGURE 3
FIGURE 3
Receiver operating characteristic (ROC) curve of the Lyon score, Milan score, acid exposure time (AET) and DeMeester score in predicting clinical improvement after antireflux therapy.
See this image and copyright information in PMC

References

    1. Lechien J. R., Vaezi M. F., Chan W. W., et al., “The Dubai Definition and Diagnostic Criteria of Laryngopharyngeal Reflux: The IFOS Consensus,” Laryngoscope 134, no. 4 (2024): 1614–1624, 10.1002/lary.31134. - DOI - PubMed
    1. Yadlapati R., Gyawali C. P., Pandolfino J. E., and CGIT GERD Consensus Conference Participants , “AGA Clinical Practice Update on the Personalized Approach to the Evaluation and Management of GERD: Expert Review,” Clinical Gastroenterology and Hepatology 20, no. 5 (2022): 984–994, 10.1016/j.cgh.2022.01.025. - DOI - PMC - PubMed
    1. Francis D. O., Rymer J. A., Slaughter J. C., et al., “High Economic Burden of Caring for Patients With Suspected Extraesophageal Reflux,” American Journal of Gastroenterology 108, no. 6 (2013): 905–911, 10.1038/ajg.2013.69. - DOI - PubMed
    1. Gyawali C. P., Yadlapati R., Fass R., et al., “Updates to the Modern Diagnosis of GERD: Lyon Consensus 2.0,” Gut 73, no. 2 (2024): 361–371, 10.1136/gutjnl-2023-330616. - DOI - PMC - PubMed
    1. Patel A., Sayuk G. S., and Gyawali C. P., “Parameters on Esophageal pH‐Impedance Monitoring That Predict Outcomes of Patients With Gastroesophageal Reflux Disease,” Clinical Gastroenterology and Hepatology 13, no. 5 (2015): 884–891. - PMC - PubMed

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