{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T04:40:04Z","timestamp":1789879204618,"version":"4.0.1"},"reference-count":37,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T00:00:00Z","timestamp":1750377600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Confidence in gastro\u2010oesophageal reflux disease (GERD) diagnosis is crucial to improve outcomes from escalation of treatment. The Lyon score phenotypes patients through endoscopy and pH\u2010impedance (MII\u2010pH). The Milan score quantifies antireflux barrier through high\u2010resolution manometry (HRM) parameters.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To explore the relationship between the Lyon and Milan scores and their combined performance in predicting clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We collected clinical and follow\u2010up data of consecutive patients with HRM and MII\u2010pH from nine centres. Clinical improvement was defined as a 50% reduction in global symptoms. The relationship between Lyon and Milan scores and the rate of patients improved in Lyon phenotypes and Milan categories were explored. The ability of the Lyon, Milan, DeMeester scores and acid exposure time (AET) in predicting outcomes was assessed through receiver operating characteristics (ROC) analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 532 patients (50.6% female, age 50\u2009years), 47.7% had pathologic GERD. A stepwise increase in the Milan score in Lyon phenotypes was observed. Sixty\u2010three patients had surgical treatment, and 131 medical. Clinical improvement in Lyon phenotypes Conclusive and Severe was 81% and 83%; in Milan categories very likely and extremely likely was 88.5% and 100%. If Lyon and Milan scores were positive, improvement was 89%; if discordant, 63%; if both negative, 19% (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). ROC analysis showed an AUC of 0.790 for Lyon score, 0.835 for Milan score, 0.736 for DeMeester score and 0.741 for AET.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The Lyon and Milan scores outperformed AET and DeMeester scores in predicting outcomes in GERD patients. When concordant, they provide optimal predictive accuracy, guiding escalation of therapy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.70245","type":"journal-article","created":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T22:07:35Z","timestamp":1750457255000},"page":"710-721","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Combined Lyon and Milan Scores Predict Gerd Management Outcome Better Than Either Score Alone or Their Individual Components"],"prefix":"10.1111","volume":"62","author":[{"given":"Stefano","family":"Siboni","sequence":"first","affiliation":[{"name":"Division of General and Emergency Surgery IRCCS Policlinico San Donato, University of Milan  Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Sozzi","sequence":"additional","affiliation":[{"name":"Division of General and Emergency Surgery IRCCS Policlinico San Donato, University of Milan  Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6985-5301","authenticated-orcid":false,"given":"Pierfrancesco","family":"Visaggi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Boveri","sequence":"additional","affiliation":[{"name":"Laboratory of Biostatistics and Data Management, Scientific Directorate IRCCS Policlinico San Donato  Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin D.","family":"Rogers","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Washington University School of Medicine  St. Louis Missouri USA"},{"name":"Division of Gastroenterology, Hepatology, and Nutrition University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1995-1060","authenticated-orcid":false,"given":"Nicola","family":"De Bortoli","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Hobson","sequence":"additional","affiliation":[{"name":"The Functional Gut Clinic  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7599-1000","authenticated-orcid":false,"given":"Brian E.","family":"Louie","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery Swedish Medical Center, Digestive Health Institute  Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6486-7717","authenticated-orcid":false,"given":"Yeong Yeh","family":"Lee","sequence":"additional","affiliation":[{"name":"School of Medical Sciences and GI Function and Motility Unit  Kota Bharu Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Tolone","sequence":"additional","affiliation":[{"name":"Division of General, Mini\u2010Invasive and Bariatric Surgery University of Naples  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Marabotto","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit IRCCS Policlinico San Martino  Genoa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan","family":"Haworth","sequence":"additional","affiliation":[{"name":"The Functional Gut Clinic  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan L.","family":"Ivy","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery Swedish Medical Center, Digestive Health Institute  Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Cusmai","sequence":"additional","affiliation":[{"name":"Division of General and Emergency Surgery IRCCS Policlinico San Donato, University of Milan  Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Campioli","sequence":"additional","affiliation":[{"name":"Division of General and Emergency Surgery IRCCS Policlinico San Donato, University of Milan  Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Theodorou","sequence":"additional","affiliation":[{"name":"Foregut Surgery Unit University of Athens School of Medicine  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania","family":"Triantafyllou","sequence":"additional","affiliation":[{"name":"Foregut Surgery Unit University of Athens School of Medicine  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1791-4506","authenticated-orcid":false,"given":"Andrea","family":"Pasta","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit IRCCS Policlinico San Martino  Genoa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4706-1499","authenticated-orcid":false,"given":"Francesco","family":"Calabrese","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit IRCCS Policlinico San Martino  Genoa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Tee","sequence":"additional","affiliation":[{"name":"School of Medical Sciences and GI Function and Motility Unit  Kota Bharu Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Bernardi","sequence":"additional","affiliation":[{"name":"Division of General and Emergency Surgery IRCCS Policlinico San Donato, University of Milan  Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo Galdino","family":"Riva","sequence":"additional","affiliation":[{"name":"Division of General and Emergency Surgery IRCCS Policlinico San Donato, University of Milan  Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"De Maron","sequence":"additional","affiliation":[{"name":"Division of General and Emergency Surgery IRCCS Policlinico San Donato, University of Milan  Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8569-2792","authenticated-orcid":false,"given":"Enrique","family":"Coss\u2010Adame","sequence":"additional","affiliation":[{"name":"Gastroenterology Department Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n  Mexico City M\u00e9xico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Duke University School of Medicine and the Durham Veterans Affairs Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Asti","sequence":"additional","affiliation":[{"name":"Division of General and Emergency Surgery IRCCS Policlinico San Donato, University of Milan  Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Savarino","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences University of Padua  Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3388-0660","authenticated-orcid":false,"given":"C. Prakash","family":"Gyawali","sequence":"additional","affiliation":[{"name":"Laboratory of Biostatistics and Data Management, Scientific Directorate IRCCS Policlinico San Donato  Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,20]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.31134"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2022.01.025"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2013.69"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102023\u2010330616"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2014.08.029"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2019.05.044"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.13777"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13116"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1091-255X(99)80071-7"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-017-5696-5"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/ueg2.12553"},{"key":"e_1_2_8_13_1","first-page":"325","article-title":"Twenty\u2010Four\u2010Hour pH Monitoring of the Distal Esophagus. A Quantitative Measure of Gastroesophageal Reflux","volume":"62","author":"Johnson L. F.","year":"1974","journal-title":"American Journal of Gastroenterology"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000003083"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/ueg2.12565"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/ueg2.12573"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2022.10.008"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14058"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12267"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.09.002"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2015.06.026"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-017-4625-8"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.45.2.172"},{"key":"e_1_2_8_24_1","first-page":"10","article-title":"Validation of Esophageal Global Symptom Severity as a Patient Reported Outcome for Evaluation of Reflux Symptoms","author":"Chan W. W.","year":"2022","journal-title":"American Journal of Gastroenterology"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2009.04142.x"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1442-2050.2007.00658.x"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0892-1997(02)00097-8"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004836-198606001-00008"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)39293-1"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14113"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(79)90008-4"},{"issue":"2","key":"e_1_2_8_32_1","first-page":"417","article-title":"The Role of the Esophageal Body in the Antireflux Mechanism","volume":"92","author":"Joelsson B. E.","year":"1982","journal-title":"Surgery"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13104"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000001756"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1980.01380040156028"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13929"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102036.2010.04315.x"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0003\u20104975(01)03407\u20105"}],"container-title":["Alimentary Pharmacology &amp; Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.70245","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T19:36:00Z","timestamp":1757532960000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apt.70245"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,20]]},"references-count":37,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1111\/apt.70245"],"URL":"https:\/\/doi.org\/10.1111\/apt.70245","archive":["Portico"],"relation":{},"ISSN":["0269-2813","1365-2036"],"issn-type":[{"value":"0269-2813","type":"print"},{"value":"1365-2036","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,20]]},"assertion":[{"value":"2025-04-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}