Wong Ming-Wun, Hsiao Shih-Hsuan, Wang Jen-Hung, Hung Jui-Sheng, Liu Tso-Tsai, Lei Wei-Yi, Yi Chih-Hsun, Chen Peir-Rong, Gyawali C Prakash, Chen Chien-Lin
Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan.
Am J Gastroenterol. 2024 Nov 26;120(9):2042-2050. doi: 10.14309/ajg.0000000000003240.
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.
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.
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).
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.
咳嗽反流评分已通过咳嗽、超重、咽部异物感、食管裂孔疝、反流和男性等参数进行验证，以预测有喉咽症状（LPS）的患者发生胃食管反流病（GERD）的可能性。本研究的目的是评估咳嗽反流评分在预测LPS患者质子泵抑制剂（PPI）反应方面的实际应用价值。
前瞻性纳入LPS持续时间超过3个月的患者，并使用反流症状指数和24小时阻抗-pH监测进行评估。根据咳嗽反流评分，将患者分为GERD可能性不大（≤2.5）、GERD不确定（3.0 - 4.5）和GERD可能性大（≥5.0）。PPI反应定义为反流症状指数降低50%。
在196名参与者（平均年龄47.8岁）中，121名GERD可能性不大，60名GERD不确定，15名GERD可能性大。与GERD不确定和可能性大的组相比，GERD可能性不大的患者夜间平均基线阻抗（MNBI）更高，食管裂孔疝患病率更低，确诊的GERD病例更少（P < 0.05）。各组间症状严重程度和酸暴露时间相似（P > 0.05）。各组的PPI反应率分别为12.4%、45.0%和73.3%（P < 0.001）。多因素逻辑回归显示，咳嗽反流评分和较低的MNBI是PPI反应性的独立预测因素（评分3.0 - 4.5，比值比（OR）= 4.190，P = 0.001；评分≥5.0，OR = 15.772，P < 0.001；MNBI，OR = 0.915，P = 0.001）。
咳嗽反流评分在预测GERD以及指导无食管炎的LPS患者使用PPI方面是有效的。该评分可确保在初次接诊LPS患者时合理使用PPI并进行针对性检测。
