62 Use of the Hospital Odynophagia Dysphagia Questionnaire as a Measure of Patient Reported Outcome in a Comparative Analysis of Achalasia Treatments

Introduction: Although achalasia is the best defined esophageal motor disorder, no standardized patient reported outcome measure currently exists for intervention trials. Furthermore, treatment outcome from a patients perspective can be quite different from the goals and assessment of the treating physician. This may reflect different levels of expectation and also a lack of a threshold definition of success. Our goal was to compare patient reported outcomes assessed with the Hospital Odynophagia Dysphagia Questionnaire (HODQ) to the clinical impression of the treating physician. Methods: 40 non-spastic achalasia patients (15F, ages 24-82) undergoing either pneumatic dilation (PD) or Heller myotomy (HM) were contacted by phone to assess clinical outcome using the HODQ. The HODQ is comprised of 10 questions related to post-procedure frequency of symptoms, severity of symptoms, and food impaction events (scores ranging 0-5 per question, max score of 50). A HODQ score ≤6 is the upper limit of normal. Post-treatment HODQ scores between HM and PD were compared. In addition, we compared the HODQ score with the clinical impression of the treating physician. A good outcome was defined as the physician's impression that the patient had a symptomatic improvement, no weight loss, and no need for further treatment. A poor response was defined as minimal to no improvement requiring further intervention. Results: Of the 40 patients, 15 had HM (3F, ages 24-65) and 25 had PD (12F, ages 22-82). The meanHODQ score after follow-up of 3-30monthswas 7.85 (SD, 8.2). Patients that underwent HM had a lower mean HODQ score compared with PD (HM, 5.7 SD (5.9); PD, 9.2, SD (9.2)), but this was not statistically significant (p=0.15). Thirty-two patients (80%) had a good clinical outcome based on the treating physician assessment, while 5 had a poor outcome and another 3 had insufficient documentation to define physician assessed outcome. Fourteen (44%) of the 32 patients deemed to have a good outcome by their physician had an abnormal HODQ score (mean 12.4, range, 7-25). Conclusion: There is substantial discepancy in physician-reported versus patient-reported outcome in achalasia treatment. Although 80% of the patients were assessed as treatment successes by their physician, 44% had a HODQ score suggesting significant persistent dysphagia. Future studies of achalasia teatment should recognize the distinction between the expectations of the patients in terms of symptom relief and the goals of reducing complications such asmalnutrition and aspiration. In addition, achalasia patients shoiuld be counseled that some dysphagia will likely persist despite successful therapy.