Gastroesophageal Reflux Disease and Reflux-like Phenotypes: Using Lyon Consensus 2.0 to Guide Clinical Approach

Gastroesophageal reflux disease (GERD) is common worldwide, but troublesome symptoms alone are not sufficient for a conclusive diagnosis. The Montreal Consensus introduced a symptom-based definition of GERD and defined mucosal injury phenotypes of the disease. The Lyon Consensus adapted mucosal injury findings as well as defined abnormal reflux burden criteria for the diagnosis of conclusive GERD. The diagnosis of esophageal disorders of gut-brain interaction (E-DGBI) using Rome V criteria requires exclusion of GERD, which is also described in the Lyon Consensus 2.0 criteria. Collectively utilizing these various criteria, distinct phenotypes can be identified in patients with troublesome reflux-like symptoms. The mucosal injury phenotype, initially defined by the Montreal Consensus, requires reflux management for healing of esophagitis to improve symptoms, and surveillance to identify and prevent GERD complications including Barrett's esophagus and esophageal adenocarcinoma. The abnormal reflux burden phenotype requires reflux management for symptom improvement. The E-DGBI phenotype requires specific management of each of the functional disorders for symptom relief. Hypervigilance and symptom-specific anxiety can overlap with all the phenotypes, and E-DGBI can coexist with conclusive GERD. Therefore, there are intricate interrelationships between Montreal, Lyon and Rome criteria that aid evaluation of troublesome symptoms, and concepts from each of these contribute to accurate phenotyping and optimal management of patients.