Validated Clinical Score to Predict Gastroesophageal Reflux in Patients With Chronic Laryngeal Symptoms: COuGH RefluX

Amanda J. Krause; Alexander M. Kaizer; Dustin A. Carlson; Walter W. Chan; Chien Lin Chen; C. Prakash Gyawali; Andrew Jenkins; John E. Pandolfino; Vinathi Polamraju; Ming Wun Wong; Madeline Greytak; Rena Yadlapati

doi:10.1016/j.cgh.2024.01.021

Validated Clinical Score to Predict Gastroesophageal Reflux in Patients With Chronic Laryngeal Symptoms: COuGH RefluX

Amanda J. Krause, Alexander M. Kaizer, Dustin A. Carlson, Walter W. Chan, Chien Lin Chen, C. Prakash Gyawali, Andrew Jenkins, John E. Pandolfino, Vinathi Polamraju, Ming Wun Wong, Madeline Greytak, Rena Yadlapati^*

^*Corresponding author for this work

Medicine, Gastroenterology Division

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Background & Aims: Discerning whether laryngeal symptoms result from gastroesophageal reflux is clinically challenging and a reliable tool to stratify patients is needed. We aimed to develop and validate a model to predict the likelihood of gastroesophageal reflux disease (GERD) among patients with chronic laryngeal symptoms. Methods: This multicenter international study collected data from adults with chronic laryngeal symptoms who underwent objective testing (upper gastrointestinal endoscopy and/or ambulatory reflux monitoring) between March 2018 and May 2023. The training phase identified a model with optimal receiver operating characteristic curves, and β coefficients informed a weighted model. The validation phase assessed performance characteristics of the weighted model. Results: A total of 856 adults, 304 in the training cohort and 552 in the validation cohort, were included. In the training phase, the optimal predictive model (area under the curve, 0.68; 95% CI, 0.62–0.74), was the Cough, Overweight/obesity, Globus, Hiatal Hernia, Regurgitation, and male seX (COuGH RefluX) score, with a lower threshold of 2.5 and an upper threshold of 5.0 to predict proven GERD. In the validation phase, the COuGH RefluX score had an area under the curve of 0.67 (95% CI, 0.62–0.71), with 79% sensitivity and 81% specificity for proven GERD. Conclusions: The externally validated COuGH RefluX score is a clinically practical model to predict the likelihood of proven GERD. The score classifies most patients with chronic laryngeal symptoms as low/high likelihood of proven GERD, with only 38% remaining as indeterminate. 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.

Original language	English (US)
Pages (from-to)	1200-1209.e1
Journal	Clinical Gastroenterology and Hepatology
Volume	22
Issue number	6
DOIs	https://doi.org/10.1016/j.cgh.2024.01.021
State	Published - Jun 2024

Funding

Funding Supported by National Institutes of Health grants 5T32DK007202-46 (Ghosh, PI), DK125266 (R.Y.), and DK135513 (R.Y.). The project described was supported in part by National Institutes of Health grant UL1TR001442. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Keywords

Diagnosis
Esophageal pH Monitoring
Esophagus
Laryngopharyngeal Reflux

ASJC Scopus subject areas

Hepatology
Gastroenterology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.cgh.2024.01.021

Cite this

Krause, A. J., Kaizer, A. M., Carlson, D. A., Chan, W. W., Chen, C. L., Gyawali, C. P., Jenkins, A., Pandolfino, J. E., Polamraju, V., Wong, M. W., Greytak, M., & Yadlapati, R. (2024). Validated Clinical Score to Predict Gastroesophageal Reflux in Patients With Chronic Laryngeal Symptoms: COuGH RefluX. Clinical Gastroenterology and Hepatology, 22(6), 1200-1209.e1. https://doi.org/10.1016/j.cgh.2024.01.021

@article{2b200b7034dd48969f7ec3ec4bf366c7,

title = "Validated Clinical Score to Predict Gastroesophageal Reflux in Patients With Chronic Laryngeal Symptoms: COuGH RefluX",

abstract = "Background & Aims: Discerning whether laryngeal symptoms result from gastroesophageal reflux is clinically challenging and a reliable tool to stratify patients is needed. We aimed to develop and validate a model to predict the likelihood of gastroesophageal reflux disease (GERD) among patients with chronic laryngeal symptoms. Methods: This multicenter international study collected data from adults with chronic laryngeal symptoms who underwent objective testing (upper gastrointestinal endoscopy and/or ambulatory reflux monitoring) between March 2018 and May 2023. The training phase identified a model with optimal receiver operating characteristic curves, and β coefficients informed a weighted model. The validation phase assessed performance characteristics of the weighted model. Results: A total of 856 adults, 304 in the training cohort and 552 in the validation cohort, were included. In the training phase, the optimal predictive model (area under the curve, 0.68; 95% CI, 0.62–0.74), was the Cough, Overweight/obesity, Globus, Hiatal Hernia, Regurgitation, and male seX (COuGH RefluX) score, with a lower threshold of 2.5 and an upper threshold of 5.0 to predict proven GERD. In the validation phase, the COuGH RefluX score had an area under the curve of 0.67 (95% CI, 0.62–0.71), with 79% sensitivity and 81% specificity for proven GERD. Conclusions: The externally validated COuGH RefluX score is a clinically practical model to predict the likelihood of proven GERD. The score classifies most patients with chronic laryngeal symptoms as low/high likelihood of proven GERD, with only 38% remaining as indeterminate. 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.",

keywords = "Diagnosis, Esophageal pH Monitoring, Esophagus, Laryngopharyngeal Reflux",

author = "Krause, {Amanda J.} and Kaizer, {Alexander M.} and Carlson, {Dustin A.} and Chan, {Walter W.} and Chen, {Chien Lin} and Gyawali, {C. Prakash} and Andrew Jenkins and Pandolfino, {John E.} and Vinathi Polamraju and Wong, {Ming Wun} and Madeline Greytak and Rena Yadlapati",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors",

year = "2024",

month = jun,

doi = "10.1016/j.cgh.2024.01.021",

language = "English (US)",

volume = "22",

pages = "1200--1209.e1",

journal = "Clinical Gastroenterology and Hepatology",

issn = "1542-3565",

publisher = "W.B. Saunders",

number = "6",

}

Krause, AJ, Kaizer, AM, Carlson, DA, Chan, WW, Chen, CL, Gyawali, CP, Jenkins, A, Pandolfino, JE, Polamraju, V, Wong, MW, Greytak, M & Yadlapati, R 2024, 'Validated Clinical Score to Predict Gastroesophageal Reflux in Patients With Chronic Laryngeal Symptoms: COuGH RefluX', Clinical Gastroenterology and Hepatology, vol. 22, no. 6, pp. 1200-1209.e1. https://doi.org/10.1016/j.cgh.2024.01.021

TY - JOUR

T1 - Validated Clinical Score to Predict Gastroesophageal Reflux in Patients With Chronic Laryngeal Symptoms

T2 - COuGH RefluX

AU - Krause, Amanda J.

AU - Kaizer, Alexander M.

AU - Carlson, Dustin A.

AU - Chan, Walter W.

AU - Chen, Chien Lin

AU - Gyawali, C. Prakash

AU - Jenkins, Andrew

AU - Pandolfino, John E.

AU - Polamraju, Vinathi

AU - Wong, Ming Wun

AU - Greytak, Madeline

AU - Yadlapati, Rena

PY - 2024/6

Y1 - 2024/6

N2 - Background & Aims: Discerning whether laryngeal symptoms result from gastroesophageal reflux is clinically challenging and a reliable tool to stratify patients is needed. We aimed to develop and validate a model to predict the likelihood of gastroesophageal reflux disease (GERD) among patients with chronic laryngeal symptoms. Methods: This multicenter international study collected data from adults with chronic laryngeal symptoms who underwent objective testing (upper gastrointestinal endoscopy and/or ambulatory reflux monitoring) between March 2018 and May 2023. The training phase identified a model with optimal receiver operating characteristic curves, and β coefficients informed a weighted model. The validation phase assessed performance characteristics of the weighted model. Results: A total of 856 adults, 304 in the training cohort and 552 in the validation cohort, were included. In the training phase, the optimal predictive model (area under the curve, 0.68; 95% CI, 0.62–0.74), was the Cough, Overweight/obesity, Globus, Hiatal Hernia, Regurgitation, and male seX (COuGH RefluX) score, with a lower threshold of 2.5 and an upper threshold of 5.0 to predict proven GERD. In the validation phase, the COuGH RefluX score had an area under the curve of 0.67 (95% CI, 0.62–0.71), with 79% sensitivity and 81% specificity for proven GERD. Conclusions: The externally validated COuGH RefluX score is a clinically practical model to predict the likelihood of proven GERD. The score classifies most patients with chronic laryngeal symptoms as low/high likelihood of proven GERD, with only 38% remaining as indeterminate. 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.

AB - Background & Aims: Discerning whether laryngeal symptoms result from gastroesophageal reflux is clinically challenging and a reliable tool to stratify patients is needed. We aimed to develop and validate a model to predict the likelihood of gastroesophageal reflux disease (GERD) among patients with chronic laryngeal symptoms. Methods: This multicenter international study collected data from adults with chronic laryngeal symptoms who underwent objective testing (upper gastrointestinal endoscopy and/or ambulatory reflux monitoring) between March 2018 and May 2023. The training phase identified a model with optimal receiver operating characteristic curves, and β coefficients informed a weighted model. The validation phase assessed performance characteristics of the weighted model. Results: A total of 856 adults, 304 in the training cohort and 552 in the validation cohort, were included. In the training phase, the optimal predictive model (area under the curve, 0.68; 95% CI, 0.62–0.74), was the Cough, Overweight/obesity, Globus, Hiatal Hernia, Regurgitation, and male seX (COuGH RefluX) score, with a lower threshold of 2.5 and an upper threshold of 5.0 to predict proven GERD. In the validation phase, the COuGH RefluX score had an area under the curve of 0.67 (95% CI, 0.62–0.71), with 79% sensitivity and 81% specificity for proven GERD. Conclusions: The externally validated COuGH RefluX score is a clinically practical model to predict the likelihood of proven GERD. The score classifies most patients with chronic laryngeal symptoms as low/high likelihood of proven GERD, with only 38% remaining as indeterminate. 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.

KW - Diagnosis

KW - Esophageal pH Monitoring

KW - Esophagus

KW - Laryngopharyngeal Reflux

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UR - http://www.scopus.com/inward/citedby.url?scp=85187008536&partnerID=8YFLogxK

U2 - 10.1016/j.cgh.2024.01.021

DO - 10.1016/j.cgh.2024.01.021

M3 - Article

C2 - 38309491

AN - SCOPUS:85187008536

SN - 1542-3565

VL - 22

SP - 1200-1209.e1

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

IS - 6

ER -

Validated Clinical Score to Predict Gastroesophageal Reflux in Patients With Chronic Laryngeal Symptoms: COuGH RefluX

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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