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.