Comparison of Reflux Symptom Index (RSI) with Reflux Finding Score (RFS) and Its Effectiveness in Diagnosis of Laryngopharyngeal Reflux Disease (LPRD)

Abstract

LPRD is a common condition in patients attending ENT OPDs. Although esophageal manometry and 24 h pH monitoring is considered the gold standard for diagnosis, it is an expensive and time consuming investigation. Newer clinical scales have been developed for diagnosing LPR such as RSI, RFS, Carlsson-Dent, ReQuest, GerdQ, etc. The objective of the study is to compare RSI with RFS and to establish its effectiveness in diagnosing LPRD among OPD patients. It’s a descriptive cross-sectional study. ENT outpatients with features of LPRD were asked to fill RSI proforma (score ≥ 13 abnormal), after which they were subjected to indirect laryngoscopy to obtain the RFS (score ≥ 7 diagnostic of LPRD). RSI was compared with RFS. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of RSI were noted. Of 165 patients, 53.9% were females. Mean RSI scores in males and females were 11.9 and 11.5 and mean RFS scores were 6.4 and 5.7 respectively. RSI had 79.1% sensitivity and 83.7% specificity in diagnosing LPRD with PPV 76.8%, NPV 85.4% and accuracy 81.8% (Chi square value 64.5, p ≤ 0.01). There was substantial agreement between RSI and RFS (Cohen’s kappa: 0.625, p ≤ 0.0001). RSI is a simple tool to diagnose LPRD which doesn’t mandate invasive procedures such as endoscopy or esophageal manometry. Hence it can be used effectively to diagnose LPRD in ENT outpatients and start the treatment at the earliest.