Universidad del Desarrollo

Laryngopharyngeal reflux symptoms (LPS) are often attributed to gastroesophageal reflux disease (GERD), yet objective testing confirms GERD in only a small subset of patients. The COuGH RefluX score, previously validated in North American and Taiwanese populations, offers a non‐invasive method to stratify GERD likelihood in patients with LPS. This study aimed to evaluate its performance in a real‐world Hispano‐American cohort.MethodsWe performed a multicenter, retrospective cohort study in 459 adult patients from seven Neurogastroenterology units in Spain and Latin America, referred for LPS between 2018 and 2024. All patients underwent endoscopy, high‐resolution esophageal manometry, and 24‐h pH or Ph‐impedance monitoring. Two versions of the COuGH RefluX score—original (including endoscopy and manometry data) and practical (including only endoscopy data)—were calculated. GERD status was defined per Lyon 2.0 criteria.Key ResultsProven GERD was identified in 164 patients (36%). The original COuGH RefluX score showed an AUC of 0.706, with 89% sensitivity and 89% specificity. The practical version showed an AUC of 0.684, maintaining the same sensitivity and specificity (both 89%). Compared to the original COuGH RefluX score, the practical version misclassified 54 patients due to undetected hiatal hernia on endoscopy alone; among these, 15 patients initially classified as indeterminate were downgraded to low likelihood—4 with proven GERD and 11 with unproven GERD. A subset of 197 (43%) patients reported at least three cough episodes during reflux monitoring. Among those with strong symptom association (n = 18), 67% had a high COuGH RefluX score, suggestive of a high GERD likelihood.ConclusionsThe COuGH RefluX score effectively stratifies GERD probability in patients with LPS. It may also identify patients with significant symptom‐reflux associations, guiding targeted testing and therapy. This pragmatic tool could improve resource allocation by reducing unnecessary invasive testing in low‐risk patients.

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