Definition of Clinically Meaningful Thresholds for the Brief Esophageal Dysphagia Questionnaire and Eckardt Score: A Multicenter Psychometric Study.

BACKGROUND

The Brief Esophageal Dysphagia Questionnaire (BEDQ) and Eckardt score (ES) are the most used patient-reported outcomes (PROs) for dysphagia. However, their patient-centered cutoffs, minimal important difference (MID), and test-retest reliability have not been established. We aimed to address these gaps and evaluate BEDQ treatment responsiveness.

METHODS

This prospective multicenter study was conducted in tertiary centers in Spain and Latin America and enrolled adults referred for high-resolution manometry. Three cohorts were derived: the cutoff cohort (subsequently subdivided into a derivation and a validation cohort), the test-retest cohort (consecutive subsample re-administered PROs), and the treatment responsiveness cohort (patients treated for achalasia). Self-perceived severity was evaluated using a 5-point Likert Patient Global Impression of Severity (PGIS) scale and applied as PGIS < 2 (No/Mild symptoms (NMSS)) and ≥ 2.

RESULTS

The cutoff cohort included 571 patients, subdivided into derivation (397) and validation (174) cohorts. A BEDQ cutoff of < 9 and ES < 4 optimally predicted NMSS. The validation cohort and bootstrapping confirmed the stability of these cutoffs. MID was 5 points for BEDQ and 1 point for ES, consistent across cohorts. BEDQ showed excellent test-retest reliability (intraclass correlation coefficient = 0.97), significantly higher than ES (0.85). Both PROs showed statistically significant reductions following treatment (p < 0.001 for both), with standardized response means of 2.14 and 1.98 for BEDQ and ES, respectively.

CONCLUSIONS

BEDQ < 9 and ES < 4 are clinically meaningful thresholds for identifying patients with NMSS. Changes exceeding 5 points for BEDQ and 1 point for ES represent clinically meaningful differences. BEDQ demonstrates superior psychometric properties compared to ES.