A Newly Proposed Severity Index for Eosinophilic Esophagitis is Associated With Baseline Clinical Features and Successful Treatment Response

• Published in: Clinical gastroenterology and hepatology Vol. 21; no. 10; pp. 2534 - 2542.e1
• Main Authors: Cotton, Cary C., Moist, Susan E., McGee, Sarah J., Furuta, Glenn T., Aceves, Seema S., Dellon, Evan S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2023
• Subjects: Deglutition Disorders; Eosinophilic Esophagitis; Eosinophilic Esophagitis - diagnosis; Eosinophilic Esophagitis - drug therapy; Eosinophilic Esophagitis - pathology; Esophagoscopy; Glucocorticoids - therapeutic use; Humans; Outcomes; Severity; Steroids; Treatment; Treatment Outcome; eos/hpf; Treatment; DSQ; I-SEE; EEsAI; EREFS; PPI; Severity; EoE; Outcomes; Eosinophilic Esophagitis; Steroids
• ISSN: 1542-3565; 1542-7714; 1542-7714
• DOI: 10.1016/j.cgh.2023.03.047

The Index of Severity for EoE (I-SEE) was recently developed. We aimed to determine the relationship between features of eosinophilic esophagitis and disease severity, and assess change in disease severity with topical corticosteroid treatment, using I-SEE. We performed a post hoc analysis of an 8-week randomized trial comparing 2 topical corticosteroid formulations in newly diagnosed patients with eosinophilic esophagitis. I-SEE was calculated at baseline and posttreatment, and patients were classified as mild (1–6 points), moderate (7–14 points), severe (≥15 points), or inactive (0 points). We analyzed clinical, endoscopic, and histologic features at baseline by disease severity, and examined the change in severity before and after treatment, and by histologic response (<15 eosinophils per high-power field). Of 111 subjects randomized, 20 (18%) were classified as mild, 75 (68%) as moderate, and 16 (14%) as severe at baseline. Increasing severity was associated with lower body mass index (30 for mild, 27 for moderate, 24 for severe; P = .01), longer duration of dysphagia symptoms before diagnosis (9 years for mild, 9 for moderate, and 20 for severe; P < .001), and decreasing esophageal diameter (15 mm for mild, 13 for moderate, and 10 for severe; P < .001). Mean severity score decreased after treatment (11 vs 4; P < .001), with lower scores in histologic responders compared with nonresponders (2 vs 9; P < .001). The severity score at baseline predicted need for dilation at follow-up (C statistic, 0.81). The newly developed I-SEE correlates with many clinical features at diagnosis, and severity improves with successful topical corticosteroid treatment. Additional investigations in other populations can further confirm its utility.