title: The Edematous and Erythematous Airway Does Not Denote Pathologic Gastroesophageal Reflux.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  The RFS cannot predict pathologic gastroesophageal reflux and an airway examination should not be used as a basis for prescribing gastroesophageal reflux therapies.
authors.affiliation: Aerodigestive Center, Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, MA. Electronic address: Rachel.rosen@childrens.harvard.edu.
authors.forename: Rachel
authors.initials: R
authors.lastname: Rosen
authors.affiliation: Clinical Research Center, Children's Hospital Boston, Boston, MA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Mitchell
authors.affiliation: Aerodigestive Center, Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, MA.
authors.forename: Janine
authors.initials: J
authors.lastname: Amirault
authors.affiliation: DuPage Children's Ear, Nose, and Throat and Allergy, Naperville, IL.
authors.forename: Manali
authors.initials: M
authors.lastname: Amin
authors.affiliation: Department of Otolaryngology, Boston Children's Hospital, Boston, MA.
authors.forename: Karen
authors.initials: K
authors.lastname: Watters
authors.affiliation: Department of Otolaryngology, Boston Children's Hospital, Boston, MA.
authors.forename: Reza
authors.initials: R
authors.lastname: Rahbar
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D003371:Cough / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007819:Laryngeal Edema / Q000175:diagnosis*; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D015588:Observer Variation; D010036:Otolaryngology / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index
keywords: endoscopy; impedance; reflux finding score