The Milan Score Predicts Objective Gastroesophageal Reflux Disease in Patients With Type 2 Esophagogastric Junction

Ferrari D 1 , Siboni S 1 , Sozzi M 1 , Visaggi P 2 , Kristo I 3 , Tolone S 4 Show all authors , Marabotto E 5 , Bernardi D 1 , Schoppmann SF 3 , Rogers BD 6 , Hobson A 7 , Haworth J 7 , Lee YY 8 , Louie BE 9 , Masuda T 10 , Ivy ML 9 , Milito P 1 , Centorrino E 1 , Theodorou D 11 , Triantafyllou T 11 , Pasta A 5 , Calabrese F 5 , Tee V 8 , Cusmai L 1 , Penagini R 12 , Coletta M 12 , Savarino E 13 , Asti E 1 , Gyawali CP 6 , De Bortoli N 2

Affiliations 

  • 1 Division of General and Emergency Surgery, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Italy
  • 2 Division of Gastroenterology, University of Pisa, Pisa, Italy
  • 3 Upper-GI-Service, Medizinische Universität, Wien, Austria
  • 4 Division of General, Mini-Invasive and Bariatric Surgery, Universita degli Studi della Campania, School of Medicine, Naples, Italy
  • 5 Gastroenterology Unit, IRCCS Policlinico San Martino, Genoa, Italy
  • 6 Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
  • 7 The Functional Gut Clinic, London, UK
  • 8 School of Medical Sciences and GI Function and Motility Unit, Universiti Sains Malaysia, Kota Bharu, Malaysia
  • 9 Division of Thoracic Surgery, Swedish Medical Center, Digestive Health Institute, Seattle, Washington, USA
  • 10 Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
  • 11 Foregut Surgery Unit, University of Athens School of Medicine, Athens, Greece
  • 12 Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
  • 13 Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
Neurogastroenterol Motil, 2025 Jan 06.
PMID: 39757994 DOI: 10.1111/nmo.14987

Abstract

INTRODUCTION: High-resolution manometry (HRM) allows assessment of esophagogastric junction (EGJ) disruption. While type 3 EGJ predicts definitive gastroesophageal reflux disease (GERD), type 2 EGJ is less clearly implicated in GERD pathogenesis. This study aimed to characterize physiologic findings in type 2 EGJ to determine if the HRM-based Milan Score can define GERD within type 2 EGJ.

METHODS: 535 patients with suspected GERD who underwent HRM and reflux monitoring were retrospectively analyzed. Clinical, HRM, and reflux study data were compared between the EGJ morphology subtypes, with objective GERD defined according to Lyon Consensus 2.0. The Milan Score, a novel metric that integrates ineffective esophageal motility, EGJ-contractile integral, EGJ morphology, and straight leg raise response, was abnormal when ≥ 137 (risk rate 50% for GERD). Receiver operating characteristic (ROC) curve analysis was performed to assess the accuracy of the Milan Score to predict objective GERD.

RESULTS: Type 3 EGJ was associated with the highest rate of objective GERD, followed by type 2 and type 1 EGJ (p 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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