Reply: Mean Nocturnal Baseline Impedance in Gastroesophageal Reflux Disease: Considerations on the Study by Lee et al

of our recent article validating the Lyon 2.0 gastroesophageal reflux disease (GERD) consensus criteria-particularly the mean nocturnal baseline impedance (MNBI)-in a Korean cohort. 2 We greatly appreciate the opportunity to clarify several key points raised in their letter.We would like to emphasize that the primary objective of our study was not to redefine diagnostic thresholds, but to assess whether the existing Lyon 2.0 criteria, including MNBI, maintain discriminative performance in an Asian clinical context.In this regard, our work aimed to provide pragmatic insight into the applicability of Lyon 2.0 criteria within a real-world Korean cohort rather than propose a new universal cutoff.First, regarding the absence of asymptomatic healthy controls, we fully agree that normative data are essential to establish population-specific reference values.Our study was designed as a retrospective clinical cohort analysis, and we acknowledge this limitation.Nevertheless, we believe that our findings provide a practical reference for clinical application until comprehensive normative data become available.Second, the classification of Los Angeles grade A esophagitis as non-GERD was based on the retrospective design and the need for dichotomization.We recognize that according to the Lyon 2.0 and Asia-Pacific consensus statements, Los Angeles grade A esophagitis should be regarded as inconclusive rather than negative for GERD.We appreciate the opportunity to clarify this point and acknowledge that this decision may have introduced minor misclassification.Third, we agree that the single-center, retrospective design and the relatively high prevalence of extra-esophageal symptoms limit generalizability.Nonetheless, the significant correlation observed between MNBI and acid exposure time (AET) supports the utility of MNBI as an adjunctive