A Severity Index May Be Clinically Useful in the Management of Patients With EoE

The Index of Severity for EoE (I-SEE) is a new tool created by a multidisciplinary team to identify meaningful features of eosinophilic esophagitis (EoE) disease activity. Its purpose for being developed is to serve as an easy-to-use tool for point-of-care use in determining EoE severity and potentially linking to important outcomes. The initial version includes 3 domains: symptoms and clinical complications, inflammatory features, and fibrostenotic features.

In this study, I-SEE was utilized to investigate the correlation between features of EoE and disease severity, as well as the change in disease severity with topical corticosteroid treatment. Investigators performed a post hoc analysis of a randomized trial that lasted 8 weeks and compared topical corticosteroids in patients newly diagnosed with EoE. Patient disease severity was categorized as mild, moderate, severe, or inactive, and clinical, endoscopic, and histologic features were evaluated at baseline by disease severity. 

Of 111 randomized patients, 20 (18%) were classified as mild, 75 (68%) as moderate, and 16 (14%) as severe at baseline. A significant association was found between increasing severity and lower body mass index, longer duration of dysphagia symptoms before diagnosis, and decreasing esophageal diameter. The mean severity score was reduced after treatment (11 vs 4; P<.001), with histologic responders having lower scores than nonresponders (2 vs 9; P<.001). Moreover, the severity score at baseline was predictive of the need for dilation at follow-up, with a C statistic of 0.81.