Lyon consensus 2.0: what has changed for GERD Diagnosis?

INTRODUCTION: The Lyon 2.0 consensus was established to further refine the original Lyon consensus and address gaps in reflux testing and endoscopic diagnosis of GERD. It represents a significant advancement in the diagnostic framework of GERD through modern definition of GERD, endoscopy findings, conclusive of GERD and reflux testing metrics and thresholds. AREAS COVERED: This is an overall review of the different aspects of GERD diagnosis that were updated in the Lyon 2 consensus compared with the original Lyon consensus. The review also provides an expert opinion of Lyon 2.0 limitations, emphasizing practical implementation challenges, evidentiary gaps, and the need for a more globally adaptable and data-driven approach. EXPERT OPINION: Lyon 2.0 consensus has markedly advanced GERD diagnosis by establishing a modern definition of GERD, identifying conclusive endoscopic findings, and introducing updated, standardized metrics and thresholds for reflux testing, along with guidance on appropriate testing both off and on therapy. However, there are several limitations to Lyon consensus that should be recognized and they include, global access disparities, dependence on specialized expertise, regional variability in normative thresholds, reliance on PPI-centric definitions, absence of structured surgical pathways, inadequate integration of nonacid pepsin-mediated injury, and inherent consensus methodology biases.