A novel high resolution
manometry tool to predict
pathologic GERD

The algorithm for pathologic GERD

The Milan score is a validated high resolution manometry screening tool that helps physicians to determine the risk of pathologic GERD. It includes four variables: EGJ type, Ineffective esophageal motility (IEM), EGJ contractile integral (EGJ-CI) and the response to the straight leg raise maneuver (SLR). The sum of each parameter generates the Milan Score and a risk rate for an acid exposure time (AET) >6% at the pH-study.


The Milan Score estimates the chance of a positive pH-study (acid exposure time>6%) combining four high resolution manometry parameters. The risk is estimated based upon informations gathered prospectively in two studies:

  1. Siboni S, Kristo I, Rogers BD, De Bortoli N, Hobson A, Louie B, Lee YY, Tee V, Tolone S, Marabotto E, Visaggi P, Haworth J, Ivy M, Greenan G, Facchini C, Masuda T, Yano F, Perry K, Balasubramanian G, Theodorou D, Triantafyllou T, Cusmai L, Boveri S, Schoppmann SF, Gyawali CP, Bonavina L. Improving the Diagnostic Yield of High-Resolution Esophageal Manometry for GERD: The “Straight Leg-Raise” International Study. Clin Gastroenterol Hepatol. 2023 Jul;21(7):1761-1770.e1. doi: 10.1016/j.cgh.2022.10.008. Epub 2022 Oct 19. PMID: 36270615.
  2. Siboni S, Sozzi M, Kristo I, Boveri S, Rogers BD, De Bortoli N, Hobson A, Louie BE, Lee YY,  Tolone S, Marabotto E, Visaggi P, Haworth J, Ivy ML, Greenan G, Masuda T, Penagini R, Barcella B, Coletta M, Theodorou D, Triantafyllou T, Facchini C, Tee V, Bonavina L, Cusmai L, Schoppmann SF, Savarino E, Asti E, Gyawali CP. The Milan Score: a novel manometric tool for a more efficient diagnosis of gastro-esophageal reflux disease. UEG Journal, 2024 1–10. Read the article.

For a more comprehensive understanding of the inclusion and exclusion criteria and the study’s methodology, we strongly encourage a thorough review of the referenced documents. It is important to be aware that the risk percentage generated by the Milan Score is an estimation and does not constitute a guarantee of specific outcomes. It should be noted that a positive pH-study result may be observed even when the associated risk is low. 

The purpose of this information is not to supplant the necessity for further diagnostic tests but to augment the diagnostic capabilities of High Resolution Manometry in cases of suspected GERD. The Authors are not responsible for medical decisions that may be made based on the risk calculator estimates.

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