The Milan Score is an Effective Manometric Tool to Predict Gastroesophageal Reflux in Patients With Laryngopharyngeal Symptoms

Introduction: According to Lyon 2.0, laryngopharyngeal symptoms (LPS) should undergo upfront pathophysiologic tests. The novel Milan score integrates esophagogastric junction (EGJ) morphology, ineffective esophageal motility, EGJ-contractile integral (EGJ-CI), and straight leg raise (SLR) response. It has been demonstrated to predict abnormal AET. The aim of this study was to assess the value of the Milan score in predicting GERD in these patients. Methods: We prospectively enrolled patients with suspected GERD who underwent HRM and MII pH from 12 referral centers. Patients with isolated LPS (reflux symptom index > 13) were compared with typical GERD symptoms (GERD-HRQL ≥ 10). A Milan score > 137 was considered positive. The effectiveness of the Milan score in the identification of patients with pathologic GERD was assessed. Results: Of 570 patients (49% females, median age 49 years, BMI 24 kg/m2), isolated LPS was found in 30 patients and isolated typical symptoms in 154. An AET > 6% was found in 23% of the LPS group and 43% of the typical symptom group (p = 0.034). The Milan score was higher in the typical symptoms group, with higher scores for EGJ-CI (p = 0.039) and SLR response (p = 0.038) components. The likelihood of concordance of the Milan score and AET on reflux monitoring was similar (83.3% vs. 84.4%, p = 0.532). Conclusions: Patients with isolated LPS demonstrated a lower likelihood of EGJ disruption, pathologic GERD, and abnormal Milan score. The Milan score performed similarly well in the identification of GERD in both LPS and typical symptoms and could therefore be used as an upfront test in LPS patients.