The Lyon Score, a Novel GERD Scoring System, Significantly Predicts Response to PPIs in GERD Patients With Chronic Cough
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Chronic cough is a frequent and troublesome extraesophageal manifestation of GERD, with poor response rates to proton pump inhibitors (PPIs) and limited diagnostic tools to predict treatment efficacy. The Lyon score, a novel composite metric integrating reflux parameters, has shown promise in typical GERD but remains untested in chronic cough. AIM: To evaluate the ability of the Lyon score to predict symptomatic response to double-dose PPI therapy in patients with suspected GERD-related cough. METHODS: We retrospectively analyzed 232 adult patients with chronic cough undergoing upper endoscopy, high-resolution manometry, and 24 h impedance-pH monitoring. PPI response was defined as ≥ 50% reduction in cough severity after ≥ 8 weeks of double-dose PPI therapy. RESULTS: Among 232 patients, 94 (40.5%) responded to PPIs. Responders had significantly higher Lyon scores (median 7.5 vs. 2.5, p < 0.0001). The Lyon score showed strong predictive performance (AUC 0.769), superior to AET (AUC 0.718) and reflux episodes (AUC 0.602), and comparable to MNBI < 1500 Ω (AUC 0.798). A Lyon score ≥ 5 had 64% sensitivity and 83% specificity. MNBI < 1500 Ω yielded 67% sensitivity and 79% specificity. The combination Lyon score or MNBI < 1500 Ω achieved optimal diagnostic accuracy (sensitivity 79%, specificity 71%, Youden index 0.50), significantly outperforming the combination Lyon score or AET > 6% (p < 0.0001). AET > 6% remained highly specific (93%) but had poor sensitivity (43%). CONCLUSION: The Lyon score is a useful tool to identify GERD-related chronic cough responsive to PPI therapy. The presence of low MNBI further improves the prediction of PPI response, supporting integration in reflux work-up for chronic cough.
Source: Neurogastroenterology & Motility
DOI: 10.1111/nmo.70218
Authors: Lorenzo Marchetti, C. Prakash Gyawali, Edoardo Vincenzo Savarino, Michele Cicala, Mentore Ribolsi
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4417019129