Validation in French of the Brief Esophageal Dysphagia Questionnaire in Patients Referred For Esophageal Manometry.

A brief esophageal dysphagia questionnaire (BEDQ) was recently developed in English to evaluate frequency and intensity of dysphagia. Our aim was to validate this questionnaire in French in a cohort of patients referred for esophageal manometry. Patients referred for esophageal high resolution manometry were offered to fill out different questionnaires including Eckart score, GERDQ score and BEDQ. BEDQ was translated in French by two French native speakers and experts in esophageal motility. Patients were grouped according to the indications of esophageal high resolution manometry (dysphagia, GERD, others). The total BEDQ score was calculated and compared between groups. The validation method used the assessment of internal consistency with Cronbach's alpha and reliability with Guttman split-half reliability. BEDQ questionnaire was completed by 608 patients (44% males, mean age 54 years). The total score had an excellent internal consistency (Cronbach's alpha = 0.90) and reliability (Guttman statistic = 0.92). The correlation was good with Eckardt score (r = 0.65, p < 0.001) but poor with the GERDQ score (r = 0.21, p < 0.01). Patients referred for dysphagia (n = 197) had an Eckardt score and a BEDQ score significantly higher than those referred for GERD or other indications (5.48 vs 3.65 and 3.53 respectively for Eckardt score and 15.85 vs 4.64 and 5.78 for BEDQ, p < 0.001). BEDQ is a valid questionnaire in French to assess dysphagia in clinical practice. It remains to be determined if this score is sensitive to symptom variation and thus useful for the follow up of patients with dysphagia.

How can we improve our practices in obstetric anal sphincter injury prevention, diagnosis, and management of symptomatic women?

Obstetric anal sphincter injury (OASI) is strongly associated with a major negative impact on women's health. Due to the consequences of an undiagnosed and therefore unrepaired OASI, it is essential to prevent or at least diagnose OASI at childbirth. We need to promote training of professionals to improve OASI screening at childbirth. High-risk situations such as operative delivery must be identified and preventive strategies such as the choice of a less traumatic instrument (vacuum) and mediolateral episiotomy should be considered. For a woman with OASI and/or symptoms, postnatal consultation with a specialist on pelvic floor disorders is essential to correctly orient her toward an adequate care pathway and to eventually identify occult or underestimated OASI. More data are required on therapeutic approaches for symptomatic women, primarily including physical therapy, sacral neuromodulation, delayed sphincter repair and palliative devices.

Validation of the French version of the esophageal hypervigilance and anxiety scale.

INTRODUCTION: An esophageal hypervigilance and anxiety scale (EHAS) was developed in English to assess the psychological process in patients with esophageal disorders. The aim of the current study was to validate this scale in French. PATIENTS AND METHODS: Patients referred for esophageal high resolution manometry (HRM) were offered to fill out different questionnaires including EHAS, Eckart score and gastro-esophageal reflux disease-questionnaire (GERDQ) score. EHAS was translated in French by 2 French native speaker experts in esophageal motility. Patients were grouped according to the indications of HRM (dysphagia, reflux, other). The total EHAS score was calculated and compared between groups. The validation method used the assessment of internal consistency with Cronbach's α and reliability with Guttman split-half reliability. RESULTS: Among the 607 patients who accepted to fill out questionnaires, the EHAS questionnaire was completed and analyzable in 469 patients. The total score had an excellent internal consistency (Cronbach's α = 0.91) and reliability (Guttman statistic = 0.86). EHAS score was not different between groups while Eckardt score was logically higher in patients with dysphagia than in others (p < 0.001) and GERDQ score was higher in patients with reflux than in those with dysphagia (p < 0.001). Despite different load on anxiety and hypervigilance scales, inter-item correlations and average scores did not differ between the original and the French EHAS. CONCLUSION: EHAS is a valid questionnaire in French. It can be interpreted using the original EHAS score. Further studies are required to demonstrate the utility of this score in patients' management.