Rachel Rosen1, Paul D Mitchell2, Janine Amirault3, Manali Amin4, Karen Watters5, Reza Rahbar5. 1. Aerodigestive Center, Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, MA. Electronic address: Rachel.rosen@childrens.harvard.edu. 2. Clinical Research Center, Children's Hospital Boston, Boston, MA. 3. Aerodigestive Center, Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, MA. 4. DuPage Children's Ear, Nose, and Throat and Allergy, Naperville, IL. 5. Department of Otolaryngology, Boston Children's Hospital, Boston, MA.
Abstract
OBJECTIVE: To determine if the reflux finding score (RFS), a validated score for airway inflammation, correlates with gastroesophageal reflux measured by multichannel intraluminal impedance (MII) testing, endoscopy, and quality of life scores. STUDY DESIGN: We performed a prospective, cross-sectional cohort study of 77 children with chronic cough undergoing direct laryngoscopy and bronchoscopy, esophagogastroduodenoscopy, and MII testing with pH (pH-MII) between 2006 and 2011. Airway examinations were videotaped and reviewed by 3 blinded otolaryngologists each of whom assigned RFS to the airways. RFS were compared with the results of reflux testing (endoscopy, MII, symptom scores). An intraclass correlation coefficient was calculated for the degree of agreement between otolaryngologists' RFS. Receiver operating characteristic curves were created to determine the sensitivity of the RFS. Spearman correlation was calculated between the RFS and reflux measurements by pH-MII. RESULTS: The mean ± SD RFS was 12 ± 4. There was no correlation between pH-MII variables and mean RFS (|r| < 0.15). The concordance correlation coefficient for RFS between otolaryngologists was low (intraclass correlation coefficient = 0.32). Using pH-metry as a gold standard, the positive predictive value for the RFS was 29%. Using MII as the gold standard, the positive predictive value for the RFS was 40%. There was no difference in the mean RFS in patients with (12 ± 4) and without (12 ± 3) esophagitis (P = .9). There was no correlation between RFS and quality of life scores (|r| < 0.15, P > .3). CONCLUSIONS: The RFS cannot predict pathologic gastroesophageal reflux and an airway examination should not be used as a basis for prescribing gastroesophageal reflux therapies.
OBJECTIVE: To determine if the reflux finding score (RFS), a validated score for airway inflammation, correlates with gastroesophageal reflux measured by multichannel intraluminal impedance (MII) testing, endoscopy, and quality of life scores. STUDY DESIGN: We performed a prospective, cross-sectional cohort study of 77 children with chronic cough undergoing direct laryngoscopy and bronchoscopy, esophagogastroduodenoscopy, and MII testing with pH (pH-MII) between 2006 and 2011. Airway examinations were videotaped and reviewed by 3 blinded otolaryngologists each of whom assigned RFS to the airways. RFS were compared with the results of reflux testing (endoscopy, MII, symptom scores). An intraclass correlation coefficient was calculated for the degree of agreement between otolaryngologists' RFS. Receiver operating characteristic curves were created to determine the sensitivity of the RFS. Spearman correlation was calculated between the RFS and reflux measurements by pH-MII. RESULTS: The mean ± SD RFS was 12 ± 4. There was no correlation between pH-MII variables and mean RFS (|r| < 0.15). The concordance correlation coefficient for RFS between otolaryngologists was low (intraclass correlation coefficient = 0.32). Using pH-metry as a gold standard, the positive predictive value for the RFS was 29%. Using MII as the gold standard, the positive predictive value for the RFS was 40%. There was no difference in the mean RFS in patients with (12 ± 4) and without (12 ± 3) esophagitis (P = .9). There was no correlation between RFS and quality of life scores (|r| < 0.15, P > .3). CONCLUSIONS: The RFS cannot predict pathologic gastroesophageal reflux and an airway examination should not be used as a basis for prescribing gastroesophageal reflux therapies.
Authors: David O Francis; Jennifer A Rymer; James C Slaughter; Yash Choksi; Pawina Jiramongkolchai; Evbu Ogbeide; Christopher Tran; Marion Goutte; C Gaelyn Garrett; David Hagaman; Michael F Vaezi Journal: Am J Gastroenterol Date: 2013-04-02 Impact factor: 10.864
Authors: Steven Shay; Radu Tutuian; Daniel Sifrim; Marcelo Vela; James Wise; Nagammapudur Balaji; Xin Zhang; Talal Adhami; Joseph Murray; Jeffrey Peters; Donald Castell Journal: Am J Gastroenterol Date: 2004-06 Impact factor: 10.864
Authors: James W Varni; Cristiane B Bendo; Samuel Nurko; Robert J Shulman; Mariella M Self; James P Franciosi; Miguel Saps; John F Pohl Journal: J Pediatr Date: 2014-09-17 Impact factor: 4.406
Authors: Marie E Jetté; Eric A Gaumnitz; Martin A Birchall; Nathan V Welham; Susan L Thibeault Journal: Laryngoscope Date: 2014-05-27 Impact factor: 3.325
Authors: Lindsey Gumer; Rachel Rosen; Benjamin D Gold; Eric H Chiou; Melanie Greifer; Sherri Cohen; Joel A Friedlander Journal: J Pediatr Gastroenterol Nutr Date: 2019-05 Impact factor: 2.839
Authors: Daniel R Duncan; Paul D Mitchell; Kara Larson; Maireade E McSweeney; Rachel L Rosen Journal: JAMA Otolaryngol Head Neck Surg Date: 2018-12-01 Impact factor: 6.223
Authors: Philip O Katz; Kerry B Dunbar; Felice H Schnoll-Sussman; Katarina B Greer; Rena Yadlapati; Stuart Jon Spechler Journal: Am J Gastroenterol Date: 2022-01-01 Impact factor: 10.864