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Updated: Jul 15, 2025
Author Spotlight: Investigating the Pathophysiology of Eosinophilic Esophagitis
Published on: May 10, 2024
The Index of Severity for Eosinophilic Esophagitis (I-SEE) Reflects Longitudinal Clinicopathologic Changes in
Andrew Dickerson1, Ayse Kolemen2, Keeler Kime2
1Division of Allergy and Immunology, Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, California; Division of Gastroenterology, Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, California.
Insights
The Index of Severity for Eosinophilic Esophagitis (I-SEE) effectively tracks disease severity in children over time. This metric improved with treatment, correlating with better clinical outcomes like improved feeding and reduced fibrosis.
Area of Science:
- Pediatric Gastroenterology
- Eosinophilic Esophagitis Research
- Disease Severity Metrics
Background:
- The Index of Severity for Eosinophilic Esophagitis (I-SEE) is a novel scoring system.
- Longitudinal data on I-SEE in pediatric cohorts are limited.
- Understanding I-SEE's responsiveness is crucial for clinical management.
Purpose of the Study:
- To evaluate I-SEE scores in a longitudinal pediatric cohort.
- To assess the relationship between I-SEE and clinical features in children with EoE.
- To determine I-SEE's responsiveness to treatment in routine care.
Main Methods:
- Retrospective analysis of a prospectively enrolled pediatric cohort.
- I-SEE calculated at diagnostic and follow-up endoscopies (mean 6.6 years).
- Analysis of clinical, endoscopic, and histologic features, including symptoms and BMI.
Main Results:
- At baseline, 43% had mild, 36% moderate, and 21% severe I-SEE scores.
- Mean I-SEE decreased significantly from 9.7 at first follow-up to 3.9 by the last instance (P < .001).
- Severe baseline I-SEE correlated with low BMI and poor feeding, which improved over time. Fibrosis also improved (P < .01).
Conclusions:
- I-SEE is a responsive severity metric in children with EoE undergoing long-term treatment.
- Baseline I-SEE scores correlate with specific clinical features like BMI and feeding difficulties.
- I-SEE aids in monitoring treatment effectiveness in pediatric eosinophilic esophagitis.
Background And Aims:
The Index of Severity for Eosinophilic Esophagitis (I-SEE) was recently developed. We aimed to understand I-SEE scores in a longitudinal pediatric cohort and to determine the relationship between I-SEE and clinical features in children.
Methods:
We performed a retrospective analysis on a prospectively enrolled cohort of children at a single center who were treated as part of routine clinical care. I-SEE was calculated at the diagnostic and follow-up endoscopies over a mean of 6.6 years. Scoring was 0 for inactive, 1-6 for mild, 7-14 for moderate, and ≥15 for severe eosinophilic esophagitis (EoE). We analyzed clinical, endoscopic, and histologic features at each instance. Symptoms were analyzed at the baseline, first follow-up, and last endoscopic instance.
Results:
Of 67 children who met study criteria of at least 3 endoscopies over at least 2 years of follow-up time, 43%, 36%, and 21% had mild, moderate, and severe I-SEE scores at baseline, respectively. Between the first and second endoscopic instances, there was a decrease in the group mean I-SEE from 9.7 ± 7.2 to 6.1 ± 5.9 (P < .001). By the last instance, the overall I-SEE score dropped to 3.9 (P < .001). Body mass index <5% and poor feeding were more common in the children with severe I-SEE scores at baseline, and both improved by the last instance. Fibrosis was improved by the last instance biopsy (P < .01).
Conclusions:
I-SEE is a responsive severity metric in children treated long term during routine clinical care. Baseline low body mass index and poor feeding were more common in children with severe I-SEE scores.
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