Development and validation of the brief esophageal dysphagia questionnaire

Abstract

Background Esophageal dysphagia is common in gastroenterology practice and has multiple etiologies. A complication for some patients with dysphagia is food impaction. A valid and reliable questionnaire to rapidly evaluate esophageal dysphagia and impaction symptoms can aid the gastroenterologist in gathering information to inform treatment approach and further evaluation, including endoscopy. Methods 1,638 patients participated over two study phases. 744 participants completed the Brief Esophageal Dysphagia Questionnaire (BEDQ) for phase 1; 869 completed the BEDQ, Visceral Sensitivity Index, Gastroesophageal Reflux Disease Questionnaire, and Hospital Anxiety and Depression Scale for phase 2. Demographic and clinical data were obtained via the electronic medical record. The BEDQ was evaluated for internal consistency, split-half reliability, ceiling and floor effects, and construct validity. Key Results The BEDQ demonstrated excellent internal consistency, reliability, and construct validity. The symptom frequency and severity scales scored above the standard acceptable cutoffs for reliability while the impaction subscale yielded poor internal consistency and split-half reliability; thus the impaction items were deemed qualifiers only and removed from the total score. No significant ceiling or floor effects were found with the exception of 1 item, and inter-item correlations fell within accepted ranges. Construct validity was supported by moderate yet significant correlations with other measures. The predictive ability of the BEDQ was small but significant. Conclusions & Inferences The BEDQ represents a rapid, reliable and valid assessment tool for esophageal dysphagia with food impaction for clinical practice that differentiates between patients with major motor dysfunction and mechanical obstruction.

High‐resolution manometry assessment of the lower esophageal sphincter after‐contraction: Normative values and clinical correlation

“…Group comparisons among metrics of contractile vigor. A Brief Esophageal Dysphagia Questionnaire ( BEDQ ) score of 10 was considered the ideal threshold to distinguish between patients with and without major esophageal motility disorders . ○, outlier; *, extreme outlier.…”

“…Incorporating the DCI+ into the HRM classification scheme may simplify the measurement of contractile vigor and was proposed as a method to improve characterization of esophageal hypercontractility. While the majority of our potentially reclassified patients were evaluated for symptoms typically associated with esophageal hypercontractility (ie, dysphagia or chest pain), a strength of our study was use of a validated dysphagia‐chest pain scale, the BEDQ, to quantify patient symptoms beyond simply using manometry‐referral indication as the method to characterize symptoms . Among the patients reclassified by DCI+ or DCI‐increment, only a portion (33‐50%, depending on criteria to define hypercontractile ) of patients reported a BEDQ score above the threshold consistent with major esophageal motility disorders .…”

“…The patient group was retrospectively identified using a query of the Esophageal Center at Northwestern (ECN) Motility Laboratory Registry, which includes English‐speaking patients aged 18‐85 that were evaluated at the ECN for esophageal symptoms with HRM. Seventy‐two consecutive patients evaluated between August, 2013 and December, 2015 were included if they had (i) an HRM motility diagnosis of normal motility, (ii) and completed the Brief Esophageal Dysphagia Questionnaire (BEDQ) . Other exclusions were: (i) previous foregut surgery, (ii) hiatal hernia ≥3 cm, or (iii) a mechanical obstruction, including esophageal eosinophilia (ie, esophageal biopsies with >15 eosinophils/hpf), which is routinely evaluated for in patients with dysphagia.…”

“…Symptoms of chest pain and dysphagia were evaluated using a validated questionnaire, the BEDQ, which was completed at the time of HRM . The questionnaire consists of eight 6‐point Likert scale questions (scored 0‐5) that assess frequency and severity of symptoms and two open‐ended questions regarding frequency of food impaction and related emergency room visits (each scored 0‐5 for ‘never’ to ‘≥4 times’).…”

“…Scores were calculated as the sum of all 10 items and ranged from 0 (asymptomatic)‐50. A BEDQ score ≥10 was considered abnormal as this threshold was determined to be the optimal cut point to distinguish patients with major esophageal motor dysfunction …”