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

Area of Science:

• Gastroenterology
• Immunology
• Clinical Medicine

Background:

• Eosinophilic esophagitis (EoE) management is guided by disease activity and severity.
• Current methods for determining EoE severity lack standardization, leading to practice variations among clinicians.

Purpose of the Study:

• To develop an international consensus severity scoring index for eosinophilic esophagitis (EoE).
• To reduce variability in clinical practice patterns for EoE management.
• To aid clinicians in monitoring EoE clinical course in office settings.

Main Methods:

• A multidisciplinary international group of experts reviewed existing literature on EoE histology, endoscopy, and symptoms.
• Three teams focused on specific EoE domains, with a steering committee reaching consensus on severity features.
• Consensus was reached on key clinicopathologic features to categorize disease 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 uses a point scale (0-6 mild, 7-14 moderate, ≥15 severe) for routine clinical visits.

Conclusions:

• The Index of Severity for Eosinophilic Esophagitis (I-SEE) is a clinically usable tool developed by experts.
• I-SEE standardizes EoE severity assessment beyond eosinophil counts, aiding management.
• Further validation and refinement of I-SEE in clinical trials and practice are recommended.