Esophagus to Small Intestine
Am J Gastroenterol. 2025;120(5):1009-1018
The Lyon score: A novel reflux scoring system based on the Lyon Consensus 2.0 that associates with treatment outcome from anti-reflux therapy
Introduction: The authors explored if a score derived from parameters from esophageal testing could increase confidence in diagnosing conclusive gastroesophageal reflux disease and in predicting outcome.
Methods: A prediction score was developed using metrics based on Lyon Consensus 2.0 thresholds extracted from endoscopy and pH-impedance monitoring. The Lyon score was the sum of weighted scores derived from a logistic regression model. The outcome was response to anti-reflux therapy, defined as 50% reduction in global symptoms on validated questionnaires. An existing database of endoscopy-negative patients with typical reflux symptoms undergoing esophageal testing from 2 centers (Europe and the United States) constituted the developmental cohort, while 2 separate cohorts (Europe and Asia) served as validation cohorts. Receiver operating characteristics analysis determined performance of the Lyon score in predicting treatment response.
Results: In 281 developmental cohort patients (median age 53 years, 57.7% female), the Lyon score demonstrated an area under the curve (AUC) of 0.819 in predicting 50% symptom improvement (p < 0.001) on receiver operating characteristics, with an optimal threshold of 6.25 (sensitivity 81.2%, specificity 73.4%). Of the individual components, only acid exposure time (AUC, 0.799, p < 0.001), mean nocturnal baseline impedance (AUC, 0.785, p < 0.001), and reflux episodes (AUC, 0.764, p < 0.001) approached the Lyon score performance. The Lyon score segregated treatment response in both the European (AUC, 0.908, p < 0.001) and Asian validation cohorts (AUC, 0.637, p < 0.001) and outperformed the DeMeester score in sensitivity for predicting outcome in the developmental and Asian validation cohorts.
Discussion: The novel Lyon score segregates reflux phenotypes and identifies likelihood of symptom response from anti-reflux therapy.