Reflux Symptoms Index

The Reflux Symptoms Index

The RSI is a nine-item self-administered outcome questionnaire administered with the purpose to document the presence and severity of laryngopharyngeal reflux (LPR) characteristic signs and symptoms.

It is a useful instrument in diagnosing LPR, along with other measures such as that of composite pH score and devising the appropriateness of potential therapies.

The Reflux symptons index consists in the following nine items:

1. Hoarseness or a problem with your voice;

2. Clearing your throat;

3. Excess throat mucous or postnasal drip;

4. Difficulty swallowing food, liquids or pills;

5. Coughing after you ate or after lying down;

6. Breathing difficulties or choking episodes;

7. Troublesome or annoying cough;

8. Sensations or something sticking in your throat;

9. Heart burn, chest pain, indigestion, or stomach acid coming up.

The patient is asked to rate each of the 9 signs and symptoms on a scale from 0 to 5, where 0 means no problem and 5 means severe problem, based on how they perceive they have been affected by the symptoms during the past month.

The RSI score ranges from 0 to 45, with scores of 13 or greater being indicative of laryngopharyngeal reflux (LPR) diagnosis.

Available treatment options (in line with LPR severity) may include diet modification, antacids, H2-receptor antagonists, proton-pump inhibitors, and fundoplication surgery.

About the original study

The RSI was developed by Belafsky et al. as at the time of the study there was no validated instrument that documented symptom severity in LPR. The psychometric properties of the RSI were then investigated.

For validity assessment, 25 patients with laryngopharyngeal reflux were evaluated prospectively before and six months after proton pump inhibitors (PPI) treatment.

Normative RSI data were derived from 25 age-matched and gender-matched controls taken from an existing database of asymptomatic individuals without any evidence of LPR. The mean pre- treatment RSI in patients with LPR was significantly higher than controls (21.2 versus 11.6; p < 0.001).

After six months of therapy:

■ The mean RSI of patients with LPR approached that of asymptomatic controls (p > 0.05).

■ The mean RSI (+/- standard deviation) of patients with LPR improved from 21.2 (+/- 10.7) to 12.8 (+/- 10.0);

■ The mean VHI improved from 52.2 (+/- 24.7) to 41.5 (+/- 25.0);

■ The single-item correlation coefficients ranged from 0.41 to 0.91 (p < 0.05 for all items).

The reflux symptoms index is considered an easily to administer too, highly reproductible and with excellent construct and criterion-based validity.

References

Original reference

Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index (RSI). 2002. J Voice, 16(2), 274-277

Other references

Lechien JR, Huet K, Finck C, Khalife M, Fourneau AF, Delvaux V, Piccaluga M, Harmegnies B, Saussez S. Validity and Reliability of a French Version of Reflux Symptom Index. J Voice. 2017 Jul;31(4):512.e1-512.e7.

Brauer DL, Tse KY, Lin JC, Schatz MX, Simon RA. The Utility of the Reflux Symptom Index for Diagnosis of Laryngopharyngeal Reflux in an Allergy Patient Population. J Allergy Clin Immunol Pract. 2018 Jan - Feb; 6(1):132-138.e1.