Esophageal Symptoms Questionnaire for the assessment of dysphagia, globus, and reflux symptoms: Initial development and validation

M. A. Kwiatek*, J. L. Kiebles, T. H. Taft, J. E. Pandolfino, M. J. Bové, P. J. Kahrilas, L. Keefer

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


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 (r s≥ 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.

Original languageEnglish (US)
Pages (from-to)550-559
Number of pages10
JournalDiseases of the Esophagus
Issue number8
StatePublished - Nov 2011


  • Dysphagia
  • Esophageal symptom
  • Globus
  • Questionnaire
  • Reflux

ASJC Scopus subject areas

  • Gastroenterology

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