© 2007 The Authors 202 Journal compilation © 2007 The International Society for Diseases of the Esophagus Diseases of the Esophagus (2007) 20, 202–205 DOI: 10.1111/j.1442-2050.2007.00670.x Blackwell Publishing Asia Questionnaire Validation of the Mayo Dysphagia Questionnaire A. B. M. Grudell, 1 J. A. Alexander, 1 F. B. Enders, 2 R. Pacifico, 3 M. Fredericksen, 1 J. L. Wise, 1 G. R. Locke III, 1,4 A. Arora, 1 T. Zais, 1 N. J. Talley, 1,4 Y. Romero 1,4,5 Divisions of 1 Gastroenterology and Hepatology and 2 Biostatistics, Mayo Clinic, Rochester, Minnesota, 3 Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, 4 GI Outcomes Research Unit and 5 Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA SUMMARY. While multiple instruments characterize upper gastrointestinal symptoms, a validated instrument devoted to the measurement of a spectrum of esophageal dysphagia attributes is not available. Therefore, we constructed and validated the Mayo Dysphagia Questionnaire (MDQ). The 27 items of the MDQ underwent content validity, feasibility, concurrent validity, reproducibility, internal consistency, and construct validity testing. To assess content validity, five esophageal subspecialty gastroenterologists reviewed the items to ensure inclusion of pertinent domains. Feasibility testing was done with eight outpatients who refined problematic items. To assess concurrent validity, 70 patient responses on the MDQ were compared to responses gathered in a structured patient-physician interview. A separate group of 70 outpatients completed the MDQ twice to assess the reproducibility of each item. A total of 148 patients participated in the validation process (78 [53%] men; mean age 62). On average, the MDQ took 6 minutes to complete. A single item (odynophagia) tested poorly with a kappa value of < 0.4. Otherwise, the majority of concurrent validity kappa values were in the good to excellent range with a mean of 0.63 (95% CI 0.22–0.89). The majority of reproducibility kappa values were also in the good to excellent range with a median kappa value of 0.76 (interquartile range: 0.67–0.81). Cronbach’s alpha values were excellent in the range of 0.86–0.88. Spearman rank correlation coefficients to assess construct validity were also excellent in the range of 0.87–0.98. Thus, the MDQ is a concise instrument that demonstrates overall excellent concurrent validity, reproducibility, internal consistency, and construct validity for the features of esophageal dysphagia. KEY WORDS : dysphagia, questionnaire, swallowing difficulty. INTRODUCTION While multiple instruments characterize a variety of upper gastrointestinal symptoms, 1–11 a validated instrument devoted to the measurement of a spectrum of esophageal dysphagia attributes is not available. An instrument designed to diagnose and gauge dysphagia severity would improve uniformity in the patients entered into clinical research trials and provide a consistent assessment tool to measure efficacy end-points. Dysphagia items have been included in the Gas- troesophageal Reflux Questionnaire, 4 the Gastroin- testinal Quality of Life Index, 3 the M.D. Anderson Dysphagia Inventory, 6 the Supraesophageal Reflux Questionnaire, 9 the SWAL-QOL, 10,11 and the modified Achalasia Symptom Score. 12 However, none of these instruments are devoted to assessing many different aspects of esophageal dysphagia in a succinct manner. While the Mayo Dysphagia Questionnaire (MDQ) shares the majority of its dysphagia items with other Mayo Clinic-developed instruments, 4,9 the 96-item Gastroesophageal Reflux Questionnaire 4 includes sections on irritable bowel syndrome, chest pain, and bowel habits, while the 29-item Supraesophageal Reflux Questionnaire 9 focuses on throat clearing, cough, globus sensation, sore throat and hoarseness. We aimed to construct and validate a simple instrument to measure dysphagia using items from Address correspondence to: Yvonne Romero, MD, Division of Gastroenterology and Hepatology, Gonda 9A, Mayo Clinic, Rochester, Rochester, MN 55905. Email: romero.yvonne@mayo.edu Grant Support: Supported in part by the Miles and Shirley Fiterman Center for Digestive Diseases at the Mayo Clinic, Rochester, MN. Yvonne Romero was supported in part by a grant from the NIH (NIDDK 02956).