ent gi-hepatology

RSI — Reflux Symptom Index

9-item self-report screen for laryngopharyngeal reflux (Belafsky 2002). Each symptom 0 (no problem) to 5 (severe). Total 0–45. Score >13 considered abnormal and triggers PPI trial / further workup.

Q1. Hoarseness or voice problem — over the last month*

Q2. Clearing your throat — over the last month*

Q3. Excess throat mucus or postnasal drip — over the last month*

Q4. Difficulty swallowing food, liquids or pills — over the last month*

Q5. Coughing after eating or lying down — over the last month*

Q6. Breathing difficulties or choking episodes — over the last month*

Q7. Troublesome or annoying cough — over the last month*

Q8. Sensation of something stuck in throat / lump — over the last month*

Q9. Heartburn, chest pain, indigestion or stomach acid coming up — over the last month*

Score interpretation

Normal — LPR unlikely 0–13

→ Reassure. Consider alternative aetiologies for symptoms (allergic rhinitis, vocal misuse, infection).

Possible LPR 14–25

→ Empirical PPI trial 8 weeks (e.g. omeprazole 20–40 mg BD), lifestyle measures (weight loss, avoid late meals, head-of-bed elevation, reduce alcohol/caffeine). Reassess RSI at 8 weeks. ENT referral with flexible nasendoscopy if persistent.

Likely LPR 26–45

→ ENT referral and flexible nasendoscopy to assess RFS. PPI BD 12 weeks ± alginate (Gaviscon) before bed. Investigate for Barrett's, peptic stricture, malignancy via gastroenterology if alarm symptoms (dysphagia, weight loss, bleeding, age >55).

Interpretation bands for the RSI. Apply clinical judgement and local guidance.

References

Curated clinical cross-links plus same-class fallbacks.

Calculators

RFS — Reflux Finding Score · Laryngopharyngeal Reflux

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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