{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T13:11:47Z","timestamp":1792156307558,"version":"4.4.0"},"reference-count":6,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T00:00:00Z","timestamp":1765411200000},"content-version":"vor","delay-in-days":40,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Achalasia treatment outcomes are often assessed using the Eckardt score, which has not been formally validated and is not designed as a patient-reported outcome (PRO) tool. To address this unmet clinical need, a group of healthcare providers developed the International Patient-oriented tool for Achalasia Symptom Score (I-PASS), which aims to record both symptom severity and frequency in a patient-oriented manner. Using the RAND\/ University of California, Los Angeles, Appropriateness Methodology, a 16-member international, multidisciplinary panel identified key symptomatic domains through three Delphi rounds. Dysphagia, regurgitation (daytime and nocturnal), and chest pain were selected as primary domains, with weight loss included as an additional factor. Severity and frequency scoring were agreed upon, resulting in a maximum composite score of 53. The pretreatment I-PASS was pilot-tested in 118 treatment-na\u00efve achalasia patients in the UK and Italy. Comprehension, completion time, acceptability, and correlation with the standard Eckardt score were assessed. All the patients completed the I-PASS. Most (96.5%) reported full comprehension, the median completion time was 10\u00a0minutes, and 98% expressed willingness to complete it again. The median I-PASS score was 29 (IQR 20\u201336), compared with a median Eckardt score of 7 (IQR 5\u20139). A strong correlation was observed between I-PASS and Eckardt (\u03c1\u00a0=\u20090.68, P\u00a0&amp;lt;\u20090.0001). Regression analysis confirmed that each one-point increase in Eckardt corresponded to a 3.1-point increase in I-PASS. The I-PASS questionnaire is feasible, well accepted, and provides a more comprehensive assessment of achalasia symptoms than the Eckardt score. Future studies will evaluate its reliability, responsiveness, and validity as a standardized PRO instrument.<\/jats:p>","DOI":"10.1093\/dote\/doaf114","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T12:53:09Z","timestamp":1764075189000},"source":"Crossref","is-referenced-by-count":2,"title":["Development of a novel patient-oriented tool to assess achalasia symptoms and response to treatment (I-PASS, International Patient-oriented tool for Achalasia Symptom Score)"],"prefix":"10.1093","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0333-9491","authenticated-orcid":false,"given":"Giovanni","family":"Zaninotto","sequence":"first","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8650-2017","authenticated-orcid":false,"given":"Sheraz R","family":"Markar","sequence":"additional","affiliation":[{"name":"Nuffield Department of Surgical Sciences, University of Oxford ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rami","family":"Sweiss","sequence":"additional","affiliation":[{"name":"Gastroenterology, University College London Hospitals NHS Foundation Trust , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renato","family":"Salvador","sequence":"additional","affiliation":[{"name":"Department of Surgical, Oncological, and Gastroenterological Sciences, School of Medicine, University of Padua , Padova ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorena","family":"Torroni","sequence":"additional","affiliation":[{"name":"Department of Medicine, Saint Camillus International University of Health and Medical Sciences , Rome ,","place":["Italy"]},{"name":"Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona , Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Casella","sequence":"additional","affiliation":[{"name":"Upper GI Surgery Division, University of Verona , Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Humayra","family":"Dervin","sequence":"additional","affiliation":[{"name":"Gastroenterology, University College London Hospitals NHS Foundation Trust , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Costantini","sequence":"additional","affiliation":[{"name":"Department of Surgical, Oncological, and Gastroenterological Sciences, School of Medicine, University of Padua , Padova ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Jamel","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Sacco","sequence":"additional","affiliation":[{"name":"Upper GI Surgery Division, University of Verona , Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the I-PASS Working Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"issue":"9911","key":"2025121107561062500_ref1","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/S0140-6736(13)60651-0","article-title":"Achalasia","volume":"383","author":"Boeckxstaens","year":"2014","journal-title":"Lancet"},{"issue":"9","key":"2025121107561062500_ref2","doi-asserted-by":"publisher","first-page":"1393","DOI":"10.14309\/ajg.0000000000000731","article-title":"ACG clinical guidelines: diagnosis and management of achalasia","volume":"115","author":"Vaezi","year":"2020","journal-title":"Am J Gastroenterol"},{"issue":"6","key":"2025121107561062500_ref3","doi-asserted-by":"publisher","first-page":"1732","DOI":"10.1016\/0016-5085(92)91428-7","article-title":"Predictors of outcome in patients with achalasia treated by pneumatic dilation","volume":"103","author":"Eckardt","year":"1992","journal-title":"Gastroenterology"},{"key":"2025121107561062500_ref4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/dote\/doy071","article-title":"The 2018 ISDE achalasia guidelines","volume":"31","author":"Zaninotto","year":"2018","journal-title":"Diseases of Esophagus"},{"key":"2025121107561062500_ref5","doi-asserted-by":"publisher","first-page":"e13287","DOI":"10.1111\/nmo.13287","article-title":"Evaluating the reliability and construct validity of the Eckardt symptom score as a measure of achalasia severity","volume":"30","author":"Taft","year":"2018","journal-title":"Neurogastroenterol Motil"},{"key":"2025121107561062500_ref6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/dote\/dow028","article-title":"Patient-report outcome measures in dysphagia: a systematic review of instrument and validation","volume":"30","author":"Patel DA","year":"2017","journal-title":"Dis Esophagus"}],"container-title":["Diseases of the Esophagus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/dote\/article-pdf\/38\/6\/doaf114\/65837624\/doaf114.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/dote\/article-pdf\/38\/6\/doaf114\/65837624\/doaf114.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T12:56:16Z","timestamp":1765457776000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/dote\/article\/doi\/10.1093\/dote\/doaf114\/8377157"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,1]]},"references-count":6,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,11,1]]}},"URL":"https:\/\/doi.org\/10.1093\/dote\/doaf114","relation":{},"ISSN":["1120-8694","1442-2050"],"issn-type":[{"value":"1120-8694","type":"print"},{"value":"1442-2050","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12]]},"published":{"date-parts":[[2025,11,1]]},"article-number":"doaf114"}}