Table 5.

Rome IV criteria for FGIDs/DGBI-ED and lyon consensus 2.0 criteria for GERD

Diagnosis	Rome IV criteria for FGIDs/DGBI-ED	Lyon criteria for GERD
Heartburn	◆Burning retrosternal discomfort or pain. ◆No symptom relief despite optimal anti-secretory therapy. ◆Absence of evidence that GER (abnormal acid exposure and symptom reflux association) or EoE (eosinophilic esophagitis) is the cause of symptoms.	◆Patient with sensation of heartburn: Repetitive heartburn (major typical symptoms). ◆Effective proton pump inhibitors (PPIs). ◆With or without GER related alarm symptoms.
Dyspphagia	◆Retrosternal symptoms including heartburn and chest pain. ◆Normal EGD (esophagogastroduodenoscopy) and absence of evidence that EoE is the cause for symptoms. ◆Absence of major esophageal motor disorders (achalasia/esophagogastrict junction outflow obstruction, diffuse esophageal spasm, jack hammer esophagus, absent peristalsis. ◆Evidence of triggering of symptoms by reflux events despite normal acid exposure on pH or pH-impedance monitoring (response to anti-secretory therapy does not exclude diagnosis). ◆Normal pH-impedance monitoring < 40, and normal acid exposure time (AET) < 4.0%.	◆With or without GER related alarm symptoms. ◆Abnormal EGD (LA-B/C/D). ◆Conclusive endoscopic criteria for GERD: LA grade C or D oesophagitis; Biopsy-proven Barrett’s oesophagus and Peptic stricture. ◆Abnormal pH-impedance monitoring and abnormal AET. ◆An AET d ≥ 6.0% is abnormal (whatever the type of reflux monitoring and whether the study was performed off or on PPI).
Chest Pain	◆Patient with chest pain of esophageal origin. ◆History and physical suggestive of esophageal etiology (exclusion of the risk of cardiac etiology). ◆No respond to PPI trial and normal upper endoscopy with bioscopy (Normal EGD). ◆Normal esophageal acid exposure and normal manometry finding.	◆Patient with chest pain of esophageal origin. ◆History and physical suggestive of esophageal etiology (exclusion of the risk of cardiac etiology). ◆Response to PPI trial and abnormal upper endoscopy with bioscopy. ◆Abnormal esophageal acid exposure and abnormal manometry finding.
FGIDs/DGBI	◆Criteria must be fulfilled for the past 3 months with symptom onset at least 6 months before diagnosis with a frequency of at least twice a week. ◆Imaging and diagnostic tests are typically normal in most patients with DGBI. ◆No respond to PPI trial and effective emotional and behavioral regulation therapy. ◆Esophagogastroduodenoscopy (EGD), esophageal pH impedance monitoring, and high-resolution esophageal manometry are necessary for the diagnosis of FGIDs, as functional heartburn or reflux hypersensitivity may overlap with GERD. ◆Capsule endoscopy and advanced microbiota sampling may be one of the non-invasive methods for diagnosing DGBI in the future.
GERD	◆Obvious symptoms during the day and night, persistent attacks and symptoms worsen after meals or when lying down. Proton pump inhibitor (PPI) trial confirms effectiveness. ◆Acid exposure time (AET) : < 4.0%(Normal), 4.0% ≤ AET < 6.0% (Uncertain/borderline GERD), and ≥ 6.0% (Abnormal/proved GERD) (149). ◆EGD: According to the classification method of Los Angeles (LA), LA sets the diagnostic criteria as LA-C/D. Among them, LA-A [One or more mucosal breaks no longer than 5 mm that do not extend between the tops of two mucosal folds], LA-B [One or more mucosal breaks longer than 5 mm that do not extend between the tops of two mucosal folds], LA-C [One or more mucosal breaks that are continuous between the tops of 2 or more mucosal folds, but involve less than 75% of the circumference], LA-D [One or more mucosal breaks that involve at least 75% of the esophageal circumference] (150). ◆Reflux episodes on pH-impedance monitoring off proton pump inhibitor therapy: < 40 [Normal] (40–80), [Uncertain], > 80 [Abnormal] (149, 150). ◆Objective proved GERD was based on a DeMeester score greater than 14.7 or LA- C or D esophagitis (151).  ◆In patients with GERD, the presence of LA-C or D oesophagitis, AET > 12.0%, DeMeester score > 50, bipositional reflux, and or a large hiatal hernia incidatiates a more severely GERD phenotype (151).