Patient-Reported Outcome Measures in Benign Esophageal Disorders

Patient-reported outcome (PRO) measures are essential tools for assessing a patient's subjective experience related to disease and health. PROs measure symptom severity and evaluate treatment efficacy across a range of conditions at a particular point in time. Although PROs focusing on esophageal symptoms and esophageal hypervigilance exist, disease-specific PROs for commonly encountered benign esophageal disorders such as gastroesophageal reflux disease (GERD), eosinophilic esophagitis (EoE), and achalasia are limited. Most GERD-specific PROs fail to address the complete spectrum of GERD presentations and those that provide daily assessment are more suited for research. Similarly, many EoE-specific PROs were designed for clinical trials. Comprehensive instruments incorporating EoE symptoms, as well as endoscopic and histologic features of active inflammation and fibrostenotic changes are needed. The psychometric properties of the Eckardt Score used for achalasia have significant limitations, stemming primarily from the dominance of dysphagia in scoring. Newer achalasia-specific PROs attempt to overcome this by capturing nuanced patient experiences. Broader symptom PROs are often used to assess esophageal symptoms across the spectrum of benign esophageal disorders, including a PRO that assesses esophageal hypervigilance and symptom-specific anxiety. Future efforts should focus on creating user-friendly PROs that comprehensively evaluate not just clinical presentation but also the disease state, which will enhance clinical symptom follow-up, quality of life assessment, and research applications. Assessments of hypervigilance and visceral anxiety will complement these applications as these measures are both a PRO and an important moderator of symptom severity and quality of life.