Select the patient's current symptom frequencies to visualize the cumulative Eckardt clinical index.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Baseline assessment of symptom severity in patients with suspected or confirmed Achalasia
Primary outcome measure for evaluating treatment response after Peroral Endoscopic Myotomy (POEM), Heller Myotomy, or Pneumatic Dilation
Standardized reporting in clinical trials for esophageal motility disorders
Target Population
Patients with idiopathic achalasia or Egj outflow obstruction. Because it relies on subjective symptom reporting, it is best used in a serial fashion to track progression over time.
Section 2
Formula & Logic
The 4 Clinical Components
01
Dysphagia: Difficulty swallowing (0: None to 3: Each meal).
02
Regurgitation: Food coming back up (0: None to 3: Each meal).
03
Retrosternal Pain: Chest pain (0: None to 3: Each meal).
A post-treatment Eckardt score of ≤ 3 is the universally accepted definition of "Clinical Success" in achalasia therapy.
Section 3
Pearls/Pitfalls
Eckardt vs. Manometry
While the Chicago Classification (Manometry) tells us *how* the esophagus is moving, the Eckardt score tells us *how the patient feels*. It is common to have improved manometry (drop in IRP) without a corresponding drop in Eckardt score if there is concurrent reflux or esophageal hypersensitivity after myotomy.
The "Chest Pain" Pitfall
Retrosternal pain is the least specific component of the score. Post-POEM chest pain may reflect new-onset GERD (acid reflux) rather than persistent achalasia, but it still increases the Eckardt score.
Performance Metrics
Excellent responsiveness to change (~90% success rate reflected by score drop in modern myotomy trials)
Simple to calculate at the bedside without a calculator
Validated in both international and regional achalasia cohorts
Section 4
Next Steps
Management Decisions
01
Persistent Score > 3 Post-Op: Perform Timed Barium Swallow and repeat HRM to assess IRP. Rule out myotomy failure vs. secondary GERD.
02
Score ≤ 3: Success. Continue routine surveillance (primarily for late GERD and rare risk of esophageal cancer).
Complementary Motility Tools
Chicago Classification v4.0 (HRM)
Timed Barium Swallow Interpretation
GERD-HRQL Questionnaire
Section 5
Evidence Appraisal
The Foundational Score
Clinical presentation and complications of achalasia.
Eckardt VF. • Gastrointestinal Endoscopy Clinics of North America. 2001;11(2):281-92. Review and validation of the scoring system established in 1992.
Developed by Dr. Volker Eckardt in Wiesbaden, Germany. Before this score, achalasia treatment was evaluated using inconsistent metrics (e.g., "improvement in swallowing" vs "less regurgitation"). Dr. Eckardt’s structured approach allowed for the rigorous comparison of Pneumatic Dilation vs. Surgery in the now-famous European Achalasia Trial.
