{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T04:39:07Z","timestamp":1789879147772,"version":"4.0.1"},"reference-count":20,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T00:00:00Z","timestamp":1746489600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>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\u2010invasive method to stratify GERD likelihood in patients with LPS. This study aimed to evaluate its performance in a real\u2010world Hispano\u2010American cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We 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\u2010resolution esophageal manometry, and 24\u2010h pH or Ph\u2010impedance monitoring. Two versions of the COuGH RefluX score\u2014original (including endoscopy and manometry data) and practical (including only endoscopy data)\u2014were calculated. GERD status was defined per Lyon 2.0 criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>Proven 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\u20144 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 (<jats:italic>n<\/jats:italic>\u2009=\u200918), 67% had a high COuGH RefluX score, suggestive of a high GERD likelihood.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The COuGH RefluX score effectively stratifies GERD probability in patients with LPS. It may also identify patients with significant symptom\u2010reflux associations, guiding targeted testing and therapy. This pragmatic tool could improve resource allocation by reducing unnecessary invasive testing in low\u2010risk patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.70072","type":"journal-article","created":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T05:46:07Z","timestamp":1746510367000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Practical Validation of the COuGH RefluX Score: A Multicenter Study in Patients From Hispano\u2010America"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3247-1539","authenticated-orcid":false,"given":"Luis G.","family":"Alcala\u2010Gonzalez","sequence":"first","affiliation":[{"name":"Digestive System Research Unit Vall d'Hebron University Hospital  Barcelona Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (Ciberehd)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1892-6317","authenticated-orcid":false,"given":"Alberto","family":"Ezquerra\u2010Duran","sequence":"additional","affiliation":[{"name":"Neurogastroenterology and Motility Unit, Gastroenterology Department, Hospital Clinic of Barcelona University of Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6138-3741","authenticated-orcid":false,"given":"Francisco Alejandro","family":"F\u00e9lix T\u00e9llez","sequence":"additional","affiliation":[{"name":"Instituto de Investigaciones M\u00e9dico\u2010Biol\u00f3gicas Universidad Veracruzana  Veracruz M\u00e9xico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Calm","sequence":"additional","affiliation":[{"name":"Motility and Functional Gut Disorders Unit University Hospital Germans Trias I Pujol  Badalona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2676-1353","authenticated-orcid":false,"given":"Fermin","family":"Estremera","sequence":"additional","affiliation":[{"name":"Gastroenterology Department Complejo Hospitalario de Navarra  Navarra Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Barber","sequence":"additional","affiliation":[{"name":"Digestive System Research Unit Vall d'Hebron University Hospital  Barcelona Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (Ciberehd)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariadna","family":"Aguilar","sequence":"additional","affiliation":[{"name":"Digestive System Research Unit Vall d'Hebron University Hospital  Barcelona Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (Ciberehd)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8331-6291","authenticated-orcid":false,"given":"Ra\u00fal Alberto","family":"Jim\u00e9nez Castillo","sequence":"additional","affiliation":[{"name":"Instituto de Investigaciones M\u00e9dico\u2010Biol\u00f3gicas Universidad Veracruzana  Veracruz M\u00e9xico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5986-6592","authenticated-orcid":false,"given":"Elizabeth","family":"Barba","sequence":"additional","affiliation":[{"name":"Neurogastroenterology and Motility Unit, Gastroenterology Department, Hospital Clinic of Barcelona University of Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Marin","sequence":"additional","affiliation":[{"name":"Motility and Functional Gut Disorders Unit University Hospital Germans Trias I Pujol  Badalona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Areste","sequence":"additional","affiliation":[{"name":"Gastroenterology Department Complejo Hospitalario de Navarra  Navarra Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0909-5192","authenticated-orcid":false,"given":"Daniel","family":"Cisternas","sequence":"additional","affiliation":[{"name":"Digestive Physiology Laboratory, Gastroenterology Unit, Cl\u00ednica Alemana de Santiago Universidad del Desarrollo  Santiago Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8569-2792","authenticated-orcid":false,"given":"Enrique","family":"Coss\u2010Adame","sequence":"additional","affiliation":[{"name":"Gastroenterolog\u00eda, Neurogastroenterolog\u00eda y Motilidad Gastrointestinal Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n \u2018Salvador Zubir\u00e1n\u2019  Mexico City 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Motility"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nmo.70072","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T18:41:56Z","timestamp":1757961716000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/nmo.70072"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,6]]},"references-count":20,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1111\/nmo.70072"],"URL":"https:\/\/doi.org\/10.1111\/nmo.70072","archive":["Portico"],"relation":{},"ISSN":["1350-1925","1365-2982"],"issn-type":[{"value":"1350-1925","type":"print"},{"value":"1365-2982","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,6]]},"assertion":[{"value":"2025-03-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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