Evaluation of the Reflux Symptom Index and the Endolaryngeal Findings Scale after Treatment in Individuals with Laryngopharyngeal Reflux

Abstract Introduction Laryngopharyngeal reflux (LPR) is a prevalent condition in outpatients visiting the otorhinolaryngological clinic, with many controversies regarding its diagnosis and follow-up. Therefore, there is a need for clinical instruments that can diagnose individuals and monitor the results of their treatment. Objective To evaluate the applicability of the scores translated and adapted to Brazilian Portuguese: Reflux Symptom Index (RSI) and Endolaryngeal Reflux Findings Scale (ERFS), as instruments for post-treatment follow-up of LPR. Method A total of 35 individuals with atypical symptoms of gastroesophageal reflux disease and with an objective diagnosis of LPR, confirmed by high digestive endoscopy and 24-hour esophageal pH-metry dual probe test were submitted to the RSI and ERFS questionnaires, used in the pre- and post-treatment of 90 days with a Proton Pump Inhibitor. Result The evaluation of RSI and ERFS in the pre- and post-treatment showed a reduction in the results of the two scores, with a higher drop in the RSI (p < 0.001) than in the ERFS (p = 0.014). Although there was an improvement in the values in 23.9 % of the individuals in the ERFS, there was no change in the category (p = 0.057), different from the RSI (p < 0.001), where there was a 67.4 % improvement in values, as well as change in category (score went from positive to negative). There was a correlation between RSI and ERFS, moderate in the pretreatment and strong in the post-treatment. Conclusion The RSI and ERFS scores, when translated and adapted for Brazilian Portuguese and applied simultaneously, can be considered a good tool for post-treatment LPR follow-up.

Tradução para o português brasileiro e adaptação cultural do Reflux Finding Score / Translation and cultural adaptation of the Reflux Finding Score into Brazilian portuguese

As manifestações supraesofágicas da Doença do Refluxo Gastroesofágico, conhecidas como Refluxo Laringofaríngeo (RLF) apresentam alta prevalência. Há dificuldade no diagnóstico, que é pautado em grande parte por sintomas sugestivos e sinais inflamatórios laringofaríngeos. Belafsky et al. propuseram um escore que pontua sinais inflamatórios laríngeos por meio de achados videolaringoscópicos, o Reflux Finding Score (RFS), de forma a diminuir a subjetividade do diagnóstico. Tal escore apresentou alta sensibilidade e reprodutibilidade na língua inglesa. OBJETIVO: Traduzimos para o português brasileiro, realizamos adaptações culturais e testamos a confiabilidade do RFS. MÉTODO: Seguindo diretrizes internacionais, foram realizadas as etapas de tradução e retrotradução por dois profissionais de forma independente e por tradutores nativos norte-americanos. O teste da versão final para avaliação da confiabilidade foi realizado a partir de 24 exames de videolaringoscopia em que os examinadores aplicaram a escala em português em cada exame por duas vezes, com intervalo mínimo de 24 horas, e avaliada a coerência intraexaminadores. RESULTADO: A tradução e adaptação cultural foi realizada de forma satisfatória. Houve facilidade de treinamento e aplicação do instrumento traduzido, além de boa reprodutibilidade e confiabilidade intraobservadores. CONCLUSÃO: Escala de Achados Endolaríngeos de Refluxo tem semelhança conceitual, semântica e de conteúdo com RFS, além de confiabilidade.

The supraesophageal manifestations of Gastroesophageal Reflux Disease commonly known as Laryngopharyngeal Reflux (LPR) are highly prevalent. The diagnosis of LPR is challenging and mostly based on suggestive symptoms and signs of inflammation at the larynx and pharynx. In order to decrease the subjectivity of clinical assessment, a score based on endolaryngeal videolaryngoscopic findings, the Reflux Finding Score (RFS), was proposed by Belafasky et al. This score has proven to be highly sensitive and reproducible in the English language. OBJECTIVE: Translate and culturally adapt the RFS into Brazilian Portuguese and test its reliability. METHOD: Following international guidelines, translation and back translation of the RFS was made by 2 independent professional translators who were native English speakers. The translated version of the RFS was then applied to the videolaryngoscopic images of 24 patients by 3 examiners twice with a 24-hour minimum interval between scoring sessions, and tested for intraobserver reliability. RESULTS: The translation and cultural adaptation were carried out satisfactorily. Examiners applied the instrument, after brief technichal training, without difficulties. Intraobserver test re-test reliability and reproducibility were high. CONCLUSION: The Portuguese version of the RFS presents semantic similarity to the English version, and with reliability.