Clinical Application of Lyon Consensus 2.0 in Asia: An Overview.

Abstract

The Lyon Consensus 2.0, published in 2023, provides an updated diagnostic framework for gastroesophageal reflux disease (GERD), emphasizing objective physiological testing and introducing the concept of "actionable GERD" to guide individualized therapy. This review evaluates the clinical applicability of this framework in Asia, where normative values require regional adaptation. Given limited access to physiological testing in primary care, an endoscopy-based strategy may be considered due to its greater availability, helping overcome diagnostic barriers. Key updates include recognizing Los Angeles grade B esophagitis as conclusive GERD evidence, adoption of prolonged wireless pH monitoring, and revised thresholds for pH-impedance studies, including mean nocturnal baseline impedance. High-resolution manometry and impedance remain important for evaluating refractory symptoms and regurgitation-predominant presentations. Challenges in Asian contexts include the limited predictive performance of Western-derived tools, such as the Lyon score, and the need for lower acid exposure thresholds. The Milan score, a novel manometry-based index, provides an assessment of anti-reflux barrier integrity and may guide selection of candidates for endoscopic anti-reflux therapies. The COuGH RefluX score, based on symptoms and risk factors, estimates GERD probability in patients with laryngeal complaints. Incorporating psychophysiological assessments, such as esophageal hypervigilance and symptom-related anxiety, can further enhance diagnostic precision and improve outcomes. Successful implementation of Lyon Consensus 2.0 in Asia will depend on contextual adaptation of diagnostic criteria and integration of accessible clinical and psychological tools.