Original article Esophageal Symptoms Questionnaire for the assessment of dysphagia, globus, and reflux symptoms: initial development and validation M. A. Kwiatek, 1 J. L. Kiebles, 2 T. H. Taft, 2 J. E. Pandolfino, 1 M. J. Bové, 3 P. J. Kahrilas, 1 L. Keefer 2 1 Esophageal Disorders Research Center and 2 Center for Psychosocial Research in GI, Division of Gastroenterology, Department of Medicine, 3 Department of Otolaryngology – Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA SUMMARY. Esophageal symptoms often co-occur. A validated self-report measure encompassing multiple esophageal symptoms is necessary to determine their frequency and severity both independently and in association with each other. Such a questionnaire could streamline the diagnostic process and guide patient management. We aimed to develop an integrative measure that provides a clinical ‘snapshot’ of common esophageal symptoms. Internal reliability and content validity of a 38-item self-report Esophageal Symptoms Questionnaire (ESQ), measuring the frequency and severity of typical esophageal symptoms using Likert-rating scales were assessed in 211 patients presenting to gastroenterology and ENT outpatient tertiary care clinics. Reproducibility, concurrent and predictive validity were evaluated using the reduced-item ESQ. The 38-item ESQ had high internal reliability. Principal component analyses and item reduction methods identified three components, to which 30 of 38 items contributed significantly, providing 59% of total variance. The test–retest correlations were moderate-to-strong for 24 of 30 new items (rs  0.44, P < 0.05). The resultant subscales measuring dysphagia (ESQ-D), globus (ESQ-G), and reflux (ESQ-R) compared well against concurrent physician’s ‘working’ diagnosis (odds ratio 1.04–1.09). The receiver operating characteristics were adequate-to-good for ESQ-D (area under the curve [AUC] = 0.87) and ESQ-G (AUC = 0.74), but poor for ESQ-R (AUC = 0.61) although it matched the content of the validated Reflux Disease Questionnaire. The brief 30-item ESQ shows good internal reliability and content validity as a summary of the extent of dysphagia, globus and reflux symptoms. As a tool measuring more than one esophageal symptom, ESQ could guide patient management by indicating which of the coexisting symptoms needs to be addressed first. KEY WORDS: dysphagia, esophageal symptom, globus, questionnaire, reflux. INTRODUCTION Although rarely life threatening, esophageal symp- toms account for a significant proportion of the current American health care costs and are the most common complaint in outpatient gastroenterology practices. Proton pump inhibitors, a mainstay therapy for gastroesophageal reflux disease (GERD), are currently among the top five most commonly prescribed and costly prescriptions in the United States. Furthermore, it is likely that this value is underestimated due to undocumented Address correspondence to: Dr Monika A. Kwiatek, PhD, Northwestern University, Feinberg School of Medicine, Department of Medicine, Division of Gastroenterology, 676 N. St. Clair Street, Suite 1400, Chicago, IL 60611-2951, USA. Email: monika.kwiatek@ gmail.com Authors’ contributions: MA Kwiatek contributed to the conception and study design, study supervision, data collection, analysis and interpretation, statistical analysis, article drafting, editing, critical revision, and final approval. JL Kiebles contributed to the conception and study design data collection and interpretation article drafting, editing, critical revision, and final approval. TH Taft contributed to the data collection, analysis and interpretation, statistical analysis, article drafting, editing, critical revision, and final approval. JE Pandolfino contributed to the conception and study design, obtaining funding, data collection and interpretation, article drafting, editing, critical revision, and final approval. MJ Bové contributed to the data collection and interpretation, article drafting, editing, critical revision, and final approval. PJ Kahrilas contributed to obtaining funding, data collection and interpretation, article drafting, editing, critical revision, and final approval. L Keefer contributed to the conception and study design, obtaining funding, data interpretation, article drafting, editing, critical revision, and final approval. Diseases of the Esophagus (2011) 24, 550–559 DOI: 10.1111/j.1442-2050.2011.01202.x © 2011 Copyright the Authors Journal compilation © 2011, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus 550 Downloaded from https://academic.oup.com/dote/article/24/8/550/2328457 by guest on 09 November 2022