Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Neurogastroenterol Motil. 2018 Jun;30(6):e13287. doi: 10.1111/nmo.13287. Epub 2018 Jan 8.
Achalasia is a disease of mechanical esophageal dysfunction characterized by dysphagia, chest pain, regurgitation, and malnutrition. The Eckardt symptom score (ESS) is the gold standard self-report assessment tool. Current guidelines outline a three-step approach to patient reported outcomes measure design. Developed prior to these policies, the ESS has not undergone rigorous testing of its reliability and validity.
Adult achalasia patients retrospectively identified via a patient registry were grouped based on treatment history. Patients were grouped PREPOST (completed ESS, GERDQ, brief esophageal dysphagia questionnaire, NIH PROMIS Global Health, high resolution manometry, timed barium esophagram prior to treatment and after) and POST (completed measures only after treatment). Clinical characteristics, treatment type and date were obtained via medical record. Standardized psychometric analyses for reliability and construct validity were performed.
107 patients identified; 83 POST and 24 PREPOST. The ESS has fair internal consistency and split-half reliability with a single factor structure. Dysphagia accounts for half the variance in ESS, while chest pain and weight loss account for 10% each. Pre-post-surgical assessment demonstrates improvements in ESS, except for weight loss. Effect sizes range from 0.24 to 2.53, with greatest change in regurgitation. Validity of the ESS is supported by modest correlations with GERDQ, HRQOL, and physiological data.
CONCLUSIONS & INFERENCES: The ESS demonstrates fair reliability and validity, with a single factor structure mostly explained by dysphagia. Based on psychometric findings, weight loss and chest pain items may be decreasing ESS reliability and validity. Further assessment of the ESS under FDA guidelines is warranted.
贲门失弛缓症是一种机械性食管功能障碍疾病，其特征为吞咽困难、胸痛、反流和营养不良。Eckardt 症状评分（ESS）是金标准的自我报告评估工具。目前的指南概述了患者报告结局测量设计的三步法。在制定这些政策之前，ESS 尚未经过可靠性和有效性的严格测试。
通过患者登记处回顾性确定成年贲门失弛缓症患者，根据治疗史进行分组。患者分为 PREPOST（ESS、GERDQ、简短食管吞咽困难问卷、NIH PROMIS 全球健康、高分辨率测压、治疗前和治疗后时间性钡餐食管造影检查均已完成）和 POST（仅治疗后完成测量）。通过病历获取临床特征、治疗类型和日期。进行了可靠性和结构有效性的标准化心理测量分析。
确定了 107 例患者；83 例 POST 和 24 例 PREPOST。ESS 具有良好的内部一致性和半分可靠性，具有单一的因子结构。吞咽困难占 ESS 变异的一半，而胸痛和体重减轻各占 10%。术前和术后评估显示 ESS 有所改善，除体重减轻外。效应大小范围从 0.24 到 2.53，反流的变化最大。ESS 的有效性得到 GERDQ、HRQOL 和生理数据的适度相关性的支持。
ESS 具有良好的可靠性和有效性，具有单一的因子结构，主要由吞咽困难解释。根据心理测量学的发现，体重减轻和胸痛项目可能会降低 ESS 的可靠性和有效性。需要根据 FDA 指南进一步评估 ESS。
