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Novel clinical score for predicting laryngopharyngeal reflux

Presented By
Dr Amanda Krause , University of California San Diego, CA, USA
DDW 2023

The new ‘COuGH RefluX Score’ model, developed to predict the risk of laryngopharyngeal reflux (LPR), employs 6 parameters to offer a reliable tool for diagnosing a condition impacting 20% of patients with chronic laryngeal symptoms. Of these, 80% are diagnosed with LPR based purely on symptoms, and 50% fail to respond to proton pump inhibitors.

The study included adults with ongoing laryngeal symptoms who underwent LPR evaluation, using either an upper gastrointestinal endoscopy or ambulatory reflux monitoring [1]. Patients were classified as LPR-positive or LPR-negative based on the evidence of gastroesophageal reflux disease.

A total of 304 patients were included, of which 130 were LPR-positive and 174 LPR-negative. LPR-positive patients were predominantly older males with higher body mass index, presenting regurgitation and cough. Conversely, LPR-negative patients often experienced globus sensation.

The optimal predictive model for the ‘COugH RefluX Score’ combines 6 parameters: the presence of cough, overweight/obesity status, globus sensation, hiatal hernia, regurgitation, and male sex. Globus emerged as a negative predictor (OR 0.51; 95% CI 0.30–0.86; P=0.01).

Patient’ scores fell into 3 categories: ≤2.5 (low LPR likelihood), between 3 and 4.5 (inconclusive), and ≥5 (high LPR likelihood). The model demonstrated an 82% sensitivity in predicting LPR  in scores over 2.5 (95% CI 0.75–0.88) and 84% specificity for scores over 5 (95% CI 0.77–0.89). The model was also examined without the hiatal hernia parameter, as this is not always readily available. The model’s reliability was confirmed even without this variable.

The study also involved salivary pepsin tests in a subgroup of patients. The inclusion of salivary pepsin tests for a patient subgroup increased the model’s overall sensitivity to 87%, with 48% of specificity.

The study’s limitations include its single-centre scope and the absence of therapeutic outcome evaluation. Nonetheless, the ‘COuGH RefluX Score’ successfully stratifies LPR likelihood, prompting further testing when necessary. Current efforts focus on the model’s external validation across 3 US and 1 international site. Preliminary results appear promising, with plans for a prospective study to validate the score against treatment outcomes.

  1. Krause A, et al. Novel clinical risk prediction score for laryngopharyngeal reflux. Lecture 936, DDW 2023, 6–9 May, Chicago, IL, USA.

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