Practical Application of the COuGH RefluX Score for Patients with Laryngopharyngeal Symptoms: Real-World Assessment in Predicting GERD and PPI Response

INTRODUCTION:The COuGH RefluX score has been validated to predict likelihood of gastroesophageal reflux disease (GERD) in patients with laryngopharyngeal symptoms (LPS) using parameters of Cough, Overweight, Globus, Hiatal Hernia, Regurgitation, and male seX. This study aimed to assess the real-world value of the COuGH RefluX score in predicting proton pump inhibitor (PPI) response in LPS patients.METHODS:Patients with LPS for >3 months were prospectively enrolled, and assessed using the Reflux Symptom Index (RSI) and 24-hour impedance-pH monitoring. Based on COuGH RefluX scores, patients were designated unlikely GERD (≤2.5), inconclusive GERD (3.0-4.5), and likely GERD (≥5.0). PPI response was defined as a 50% reduction in RSI.RESULTS:Among 196 participants (mean age 47.8), 121 were unlikely, 60 were inconclusive, and 15 were likely to have GERD. Patients unlikely to have GERD had higher MNBI, lower hiatal hernia prevalence, and fewer confirmed GERD cases compared to inconclusive and likely GERD groups (P <0.05). Symptom severity and AET were similar across groups (P >0.05). PPI response rates were 12.4%, 45.0%, and 73.3% across the groups (P <0.001). Multivariate logistic regression showed COuGH RefluX scores and lower MNBI as independent predictors of PPI responsiveness (scores 3.0-4.5, OR =4.190, P =0.001; scores ≥5.0, OR =15.772, P <0.001; MNBI, OR =0.915, P =0.001).DISCUSSION:The COuGH RefluX score is effective in predicting GERD and guiding PPI use in LPS patients without esophagitis. The score can ensure appropriate PPI use and targeted testing during initial LPS patient encounters.