Gastroesophageal Reflux Disease: Diagnostic Criteria and Current Assessment Methods

• DOI: https://doi.org/10.22533/at.ed.15953325281011

• Palavras-chave: Gastroesophageal Reflux Disease; Diagnosis; Ambulatory pH Monitoring; Esophageal Impedance; Lyon Consensus; Erosive Esophagitis

• Keywords: Gastroesophageal Reflux Disease; Diagnosis; Ambulatory pH Monitoring; Esophageal Impedance; Lyon Consensus; Erosive Esophagitis

• Abstract:

  Gastroesophageal reflux disease (GERD) is one of the most prevalent gastrointestinal disorders, defined by the retrograde flow of gastric contents that causes uncomfortable symptoms and/or complications. Its pathogenesis is multifactorial, involving not only hydrochloric acid, but also components such as pepsin and bile acids. Diagnosis based solely on typical symptoms, such as heartburn and regurgitation, is considered insufficient and nonspecific, especially in extraesophageal presentations (EER), such as chronic cough and laryngitis, or in specific populations, such as neonates, leading to overdiagnosis and overtreatment. The objective of this review is to summarize the current diagnostic criteria for GERD, with an emphasis on the use of objective assessment methods. This work is based on a narrative review of the literature. Modern diagnostic criteria, consolidated by the Lyon 2.0 Consensus, require objective and conclusive evidence of pathological reflux. Upper gastrointestinal endoscopy is essential, with grade B, C, or D erosive esophagitis (EE) (Los Angeles classification), peptic stenosis, or Barrett's esophagus being conclusive for diagnosis. In patients with normal endoscopy (Non-Erosive Reflux Disease - NERD), outpatient reflux monitoring is essential. The diagnostic approach is stratified between "unproven GERD" (test performed without medication) and "proven GERD" (test performed while on medication). Acid exposure time (AET) > 6% is the gold standard for diagnosis, while an AET < 4% excludes pathological GERD. Impedance-pH monitoring (pH-MII) is crucial for evaluating refractory patients, identifying weakly acidic or non-acidic reflux, and using adjunct metrics such as Mean Nocturnal Baseline Impedance (MNBI) and total number of reflux episodes. Standardization of objective criteria is essential to define "actionable GERD," allowing for personalized management and avoiding unnecessary use of proton pump inhibitors (PPIs).