S822 Symptoms Speak Louder Than Scores: Predicting Quality-of-Life Related to Esophageal Symptoms With EASY-E Questionnaire

Introduction: Validated esophageal patient-reported outcomes (PRO) emphasize the effect of bolus transit and acid exposure but may underrepresent the impact of other symptoms relevant to quality of life (QOL). This study aimed to identify which specific esophageal symptoms are most strongly associated with patient-reported QOL. Methods: We conducted a cross-sectional analysis of 832 patients referred to an esophageal specialty clinic who completed the Emory Assessment of Symptoms in the Esophagus (EASY-E) questionnaire, an 11-item tool rated on a Likert-scale (0 = none to 3 = horribly), along with validated PROs: Gastroesophageal Reflux Disease Questionnaire, Reflux Score Index, Brief Esophageal Dysphagia Questionnaire, Eckardt Score, and Esophageal Hypervigilance and Anxiety Scale. Patient-Reported Outcomes Measurement Information System (PROMIS)-10 Physical and Mental Health t-scores served as outcomes. Internal consistency was assessed by correlating EASY-E items with corresponding validated PROs. Associations with PROMIS scores were evaluated using Spearman correlations, multivariable linear regression, and Least Absolute Shrinkage and Selection Operator (LASSO). Results: Our prior clinic data has shown typical diagnoses: gastroesophageal reflux disease (53%), esophagogastric junction outflow obstruction (22%), spastic/hypercontractile esophageal dysmotility (16%), achalasia (12%), and eosinophilic esophagitis (11%). In the present cohort, PROMIS scores were skewed left compared to national norms (mean physical = 42.4, mental = 41.5), with 77.4% and 84.5% of patients scoring below average, and over 50% below the 25th percentile. Internal consistency analysis confirmed strong alignment between EASY-E items and validated PROs. In multivariable models, shortness of breath, chest pain, and bloating were most strongly associated with worse physical QOL (linear regression adjusted R² = 0.30), while bloating, hiccups, and shortness of breath were less strongly associated with diminished mental QOL (adjusted R² = 0.12). LASSO regression confirmed these individual symptoms as dominant predictors over aggregate PRO scores. Conclusion: In this esophageal cohort, specific symptom items often omitted or diluted in validated PROs—shortness of breath, bloating, chest pain, and hiccups— emerged as the strongest determinants of impaired QOL. These findings support comprehensive item-level symptom assessment in optimizing esophageal care. Future research may assess whether such comprehensive symptom assessments offer similar value in gastric conditions.