Validity and Reliability of the Burp Score

Abstract

Objective: To investigate the validity and the reliability of the Burp Score, a patient-reported outcome questionnaire documenting the retrograde cricopharyngeal dysfunction (R-CPD) symptoms.

Study design: Prospective controlled study.

Methods: R-CPD Patients were consecutively recruited from 2 hospitals between September 2024 and April 2025. Patients and healthy individuals completed the Burp score twice within a 7-day period to assess test-retest reliability. Internal consistency was measured using Cronbach's α for the Burp items in patients and controls. Validity was evaluated by comparing the Burp with the reflux symptom score-12 (RSS-12). The Burp score was completed 3 to 6 months after the EMG-guided botulinum toxin injection (BTI) to evaluate the responsiveness to change. The minimal clinically important difference (MCID) was evaluated by receiver operating characteristic (ROC) analysis.

Results: Eighty R-CPD patients (46 females) completed the baseline evaluations. Of the 134 screened controls, 34 (22.4%) were excluded because unable to burp. Test-retest reliability (r_s = 0.911) and internal consistency reliability (α = 0.870) were high. Burp Score reported a moderate but significant external validity indicated by a significant correlation with the RSS-12 (r_s = 0.533). Internal validity was excellent regarding the significant differences between the Burp Score of R-CPD patients versus controls (P = .001). Burp score significantly decreased from pre- to posttreatment, indicating a high responsiveness to change. ROC analysis reported a MCID of 11.0 to consider the treatment partially or fully effective.

Conclusion: The Burp score is a valid and reliable patient-reported outcome questionnaire documenting R-CPD symptoms and assessing their related pretreatment to posttreatment severity and frequency.

Keywords: abelching; belching; burp; cricopharyngeal dysfunction; otolaryngology; retrograde; score; symptoms.