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

Area of Science:

• Gastroenterology
• Diagnostic Medicine
• Clinical Outcomes Research

Background:

• Accurate diagnosis of gastro-oesophageal reflux disease (GERD) is vital for effective treatment.
• The Lyon score uses endoscopy and pH-impedance (MII-pH) for patient phenotyping.
• The Milan score assesses the antireflux barrier using high-resolution manometry (HRM) parameters.

Purpose of the Study:

• To investigate the relationship between the Lyon and Milan scores.
• To evaluate their combined performance in predicting clinical outcomes for GERD patients.

Main Methods:

• Collected clinical and follow-up data from 532 GERD patients across nine centers.
• Utilized high-resolution manometry (HRM) and pH-impedance (MII-pH) measurements.
• Assessed predictive ability using receiver operating characteristic (ROC) analysis.

Main Results:

• A stepwise increase in Milan score was observed across Lyon phenotypes.
• Clinical improvement rates were high for concordant positive Lyon and Milan scores (89%).
• Milan score demonstrated superior predictive accuracy (AUC 0.835) compared to DeMeester score and acid exposure time.

Conclusions:

• Lyon and Milan scores are superior to traditional metrics like DeMeester score and acid exposure time for predicting GERD outcomes.
• Concordant Lyon and Milan scores provide optimal predictive accuracy.
• These scores can effectively guide escalation of therapy in GERD management.