Score validated to assess patients with laryngeal symptoms for risk of GERD

In a study of 856 adults with chronic laryngeal symptoms, researchers created and validated a risk score, called COuGH RefluX, that is 79% sensitive and 81% specific for identifying gastroesophageal reflux disease (GERD).

A new score was developed and validated to predict likelihood that laryngeal symptoms stem from gastroesophageal reflux disease (GERD) in a recent study.

To develop and validate the score for GERD among patients with chronic laryngeal symptoms, including throat clearing, mucus in throat, sore throat, dysphonia, cough, and globus sensation, researchers conducted a multicenter international study among adults who underwent upper GI endoscopy and/or ambulatory reflux monitoring from March 2018 to May 2023. Results appeared Feb. 1 in Clinical Gastroenterology and Hepatology.

Model training phase data were collected at a single center; model validation phase data were collected from five centers, including four GERD referral centers across the U.S. In the study, 304 adults were included in training cohort and 552 in the validation cohort.

In the training phase, the optimal predictive model (area under the curve [AUC], 0.68; 95% CI, 0.62 to 0.74) was found to include Cough, Overweight/obesity, Globus, Hiatal Hernia, Regurgitation, and male seX (COuGH RefluX), with a lower threshold of 2.5 and upper threshold of 5.0 to predict GERD. In the validation phase, the COuGH RefluX score had an AUC of 0.67 (95% CI, 0.62 to 0.71) with 79% sensitivity and 81% specificity for proven GERD.

The score classifies most patients with chronic laryngeal symptoms as having either low or high likelihood of proven GERD, with only 38% remaining as indeterminate, and it has the potential to reduce testing in more than 60% of patients undergoing evaluation for laryngopharyngeal reflux, the study authors noted.

"Thus, the CouGH RefluX score can guide diagnostic strategies and reduce inappropriate proton pump inhibitor use or testing for patients referred for evaluation of chronic laryngeal symptoms," they wrote.