{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T17:43:16Z","timestamp":1785519796694,"version":"3.56.0"},"reference-count":37,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T00:00:00Z","timestamp":1646006400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>A hierarchical approach for gastro\u2010oesophageal reflux disease (GERD) diagnosis by impedance\u2010pH monitoring was proposed by the Lyon Consensus, based on acid exposure time (AET) and supportive impedance metrics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To establish the clinical value of Lyon Consensus criteria in the work\u2010up of patients with proton pump inhibitory (PPI)\u2010refractory heartburn.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Expert review of off\u2010therapy impedance\u2010pH tracings from unproven GERD patients with PPI\u2010refractory heartburn prospectively evaluated at referral centers. Impedance metrics, namely total reflux episodes, postreflux swallow\u2010induced peristaltic wave index, and mean nocturnal baseline impedance, were assessed. Expert review of on\u2010therapy preoperative impedance\u2010pH tracings from a separate cohort of surgically treated erosive\/nonerosive GERD cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Off\u2010therapy, normal, inconclusive, and abnormal AET was found in 59%, 17%, and 23% of 317 cases. Supportive evidence of GERD was provided by abnormal impedance metrics in up to 22% and 62% of cases in the normal and inconclusive AET groups, respectively. Adding the cases with inconclusive AET and abnormal impedance metrics to the abnormal AET group, a significant increase in GERD evidence was observed (from 23% to 37% of cases, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.0002). At the on\u2010therapy presurgical evaluation, abnormal\/inconclusive AET and supraphysiological values of impedance metrics showed ongoing reflux in 21% and 90% of 96 cases, respectively (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.00001); a relationship between on\u2010therapy ongoing reflux and PPI\u2010refractory heartburn was confirmed by the favorable surgical outcome at 3\u2010year follow\u2010up, 88% of cases being in persistent off\u2010PPI heartburn remission.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Impedance\u2010pH monitoring, off\u2010 and on\u2010therapy, is of high clinical value in the work\u2010up of patients with PPI\u2010refractory heartburn.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.16838","type":"journal-article","created":{"date-parts":[[2022,3,1]],"date-time":"2022-03-01T04:54:35Z","timestamp":1646110475000},"page":"1423-1430","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Applying Lyon Consensus criteria in the work\u2010up of patients with proton pump inhibitory\u2010refractory heartburn"],"prefix":"10.1111","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8608-1563","authenticated-orcid":false,"given":"Marzio","family":"Frazzoni","sequence":"first","affiliation":[{"name":"Digestive Pathophysiology Unit Azienda Ospedaliero\u2010Universitaria di Modena Ospedale Civile di Baggiovara  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7084-6157","authenticated-orcid":false,"given":"Leonardo","family":"Frazzoni","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Department of Medical and Surgical Sciences IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna Policlinico S Orsola\u2010Malpighi  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5102-1758","authenticated-orcid":false,"given":"Mentore","family":"Ribolsi","sequence":"additional","affiliation":[{"name":"Digestive Disease Universit\u00e0 Campus Bio\u2010Medico di Roma Facolt\u00e0 Dipartimentale di Medicina e Chirurgia  Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola De","family":"Bortoli","sequence":"additional","affiliation":[{"name":"Department of New Technologies and Translational Research in Medicine and Surgery University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Tolone","sequence":"additional","affiliation":[{"name":"General and Bariatric Surgery Unit, Department of Surgery Seconda Universit\u00e0 degli Studi di Napoli Facolt\u00e0 di Medicina e Chirurgia  Caserta Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Russo","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Unit Azienda Ospedaliero\u2010Universitaria di Modena Ospedale Civile di Baggiovara  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Conigliaro","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Unit Azienda Ospedaliero\u2010Universitaria di Modena Ospedale Civile di Baggiovara  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6918-9479","authenticated-orcid":false,"given":"Roberto","family":"Penagini","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology and Transplantation Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico  Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8618-2447","authenticated-orcid":false,"given":"Lorenzo","family":"Fuccio","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Department of Medical and Surgical Sciences IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna Policlinico S Orsola\u2010Malpighi  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9949-8619","authenticated-orcid":false,"given":"Rocco Maurizio","family":"Zagari","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Department of Medical and Surgical Sciences IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna Policlinico S Orsola\u2010Malpighi  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Savarino","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oncology and Gastroenterology University of Padua School of Medicine and Surgery  Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,2,28]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2008.08.044"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.444"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41395-018-0045-4"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2017.07.040"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-314722"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2017.09.047"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1053\/gast.1996.1101981"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2009.670"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm14075"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14075"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2015.06.026"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14085"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12947"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00535-016-1226-9"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102021\u2010325531"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2020.04.031"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000000734"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.09.002"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13116"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41395-018-0044-5"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2016.02.012"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.03.057"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.03.063"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2011.07.009"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2021.07.004"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000001389"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.13777"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm16115"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm19056"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2019.05.044"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14153"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1811424"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200006223422506"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200006223422507"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2020.01.037"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000001538"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2012.12.006"}],"container-title":["Alimentary Pharmacology &amp; Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.16838","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/apt.16838","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.16838","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T02:18:29Z","timestamp":1692843509000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apt.16838"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,28]]},"references-count":37,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2022,6]]}},"alternative-id":["10.1111\/apt.16838"],"URL":"https:\/\/doi.org\/10.1111\/apt.16838","archive":["Portico"],"relation":{},"ISSN":["0269-2813","1365-2036"],"issn-type":[{"value":"0269-2813","type":"print"},{"value":"1365-2036","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,28]]},"assertion":[{"value":"2021-12-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-02-07","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-02-28","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}