Practical Application of the COuGH RefluX Score for Patients With Laryngopharyngeal Symptoms: Real-World Assessment in Predicting Gastroesophageal Reflux Disease and Proton-Pump Inhibitor 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. The aim of this study was to assess the real-world value of the COuGH RefluX score in predicting proton-pump inhibitor (PPI) response in patients with LPS.METHODS:Patients with LPS for > 3 months were prospectively enrolled and assessed using the Reflux Symptom Index 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 Reflux Symptom Index.RESULTS:Among 196 participants (mean age 47.8 years), 121 were unlikely, 60 were inconclusive, and 15 were likely to have GERD. Patients unlikely to have GERD had higher mean nocturnal baseline impedance (MNBI), lower hiatal hernia prevalence, and fewer confirmed GERD cases compared with inconclusive and likely GERD groups (P < 0.05). Symptom severity and acid exposure time 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, odds ratio (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 patients with LPS without esophagitis. The score can ensure appropriate PPI use and targeted testing during initial LPS patient encounters.