A Clinical Severity Index for Eosinophilic Esophagitis: Development, Consensus, and Future Directions

Area of Science:

• Gastroenterology
• Immunology
• Clinical Medicine

Background:

• Disease activity and severity in eosinophilic esophagitis (EoE) influence treatment decisions.
• Current methods for determining EoE severity lack standardization among practitioners.
• Variability in practice patterns necessitates a unified approach to EoE management.

Purpose of the Study:

• To develop an international consensus severity scoring index for EoE.
• To reduce variability in clinical practice patterns for EoE management.
• To aid clinicians in monitoring the clinical course of EoE in outpatient settings.

Main Methods:

• A multidisciplinary international group of experts reviewed existing literature on EoE histology, endoscopy, and symptoms.
• Three expert teams focused on progression and severity across key clinicopathologic domains.
• A steering committee convened a virtual meeting to reach consensus on salient features of EoE severity.

Main Results:

• A simplified scoring system, the Index of Severity for Eosinophilic Esophagitis (I-SEE), was created.
• I-SEE collates symptom features, complications, and endoscopic/histologic findings.
• The index categorizes EoE severity as mild (0-6), moderate (7-14), or severe (≥15) points.

Conclusions:

• The I-SEE scoring system was iteratively developed by experts to be clinically usable.
• I-SEE standardizes EoE severity assessment beyond eosinophil counts, guiding management.
• Further validation and refinement of I-SEE using clinical trial and practice data are recommended.