P1.030. The Lyon Score and Phenotypes in Patients With Symptoms Poorly Responsive to a Standard Dose of Acid Suppressive Agents

Topic Benign Disease: Gastro-Esophageal Reflux and Hiatal Hernia Background The Lyon scoring system can stratify symptoms into phenotypes associated with the likelihood of GERD diagnosis and response to anti-reflux therapy. We applied the Lyon scoring system in patients with symptoms poorly responsive to acid suppressive agents and compared the distribution of phenotypes between the typical and atypical symptom groups. Methods Data on consecutive patients, who were referred for the evaluation of esophageal and/or supra-esophageal symptoms poorly responsive to a standard dose of PPIs or PCABs for a minimum of 4 weeks and underwent upper endoscopy, high resolution esophageal manometry and ambulatory pH-impedance monitoring, were analyzed. These patients presented with typical reflux symptoms, such as heartburn, regurgitation and esophageal chest pain and/or atypical supra-esophageal symptoms, such as globus, cough, and sore throat. The Lyon scoring system reported by Gyawali CP, et al., published in 2024, was applied and stratified the symptom groups into phenotypes. Symptom groups are subclassified as the typical symptom alone group (n=72), combined symptom group with both typical and atypical symptoms (n=33), and atypical symptom alone group (n=42). The proportions of the Lyon score below 6.25, indicating the poor responsiveness to anti-reflux therapy, was compared between symptom groups. Results No GERD was the most prevalent, followed by reflux hypersensitivity, in all symptom groups. The proportion of conclusive GERD was 11.1% in the typical symptom alone group and 15.2% in the combined symptom group, whereas conclusive GERD was not observed in the atypical symptom alone group. The Lyon score of the atypical symptom alone group was significantly lower than that of the typical symptom alone group (1.1 ± 1.2 vs 2.4 ± 3.0; P = 0.012) and that of the combined symptom group (1.1 ± 1.2 vs 2.7 ± 3.4; P = 0.006). The proportion of patients likely to respond poorly to anti-reflux therapy was significantly greater in the atypical symptom alone group, compared with the typical symptom alone group (100% vs 87.5%; P = 0.017) and combined symptom group (100% vs 78.8%; P = 0.002). Conclusion No GERD and reflux hypersensitivity are the main phenotypes in patients with typical GERD and/or atypical supra-esophageal symptoms poorly responsive to a standard dose of acid suppressive agents. The likelihood of response to anti-reflux therapy is the lowest in the atypical supra-esophageal symptom alone group.