Definition of Clinically Meaningful Thresholds for the Brief Esophageal Dysphagia Questionnaire and Eckardt Score: A Multicenter Psychometric Study
Year: 2026
Type: article
Study design: Observational Study
Abstract: 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.
Source: Neurogastroenterology & Motility
DOI: 10.1111/nmo.70431
Authors: Eugenia Morales, Esteban Glasinovic, José María Remes‐Troche, Karla García‐Zermeño, Juan Pablo García Marmolejo, Albis Hani, Andrés Ardila‐Hani, Andrés Ditaranto, Joaquin Agotegaray, Claudio Bilder, Hugo Monrroy, Paula Rey, José Ignacio Gran, Jordi Serra, Luis G. Alcalá‐González, Claudia Barber‐Caselles, Dustin A. Carlson, Daniel Cisternas
Institutions: Clínica Alemana, Universidad Veracruzana, Pontificia Universidad Javeriana, Clínica Medellín SAS, Fundacion Favaloro Hospital Universitario, Pontificia Universidad Católica de Chile, Vall d'Hebron Hospital Universitari, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Northwestern University, Northwestern Medicine
Language: English
Subfield: Speech and Hearing
Field: Health Professions
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7212168665