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Published on: May 10, 2024
The Eosinophilic Esophagitis Severity Index Reflects Response to Budesonide Orodispersible Tablets During Induction
Gaia Pellegatta1, Francesca Paola Giugliano2, Valeria Poletti2
1Endoscopy Unit, IRCCS Humanitas Research Hospital Department of Gastroenterology, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Background & Aims:
The Index of Severity for Eosinophilic Esophagitis (I-SEE) is a composite tool used to stratify patients with eosinophilic esophagitis (EoE) according to severity. We assessed longitudinal changes in I-SEE scores in patients treated with budesonide orodispersible tablets (BOTs) during induction and maintenance and its association with clinical outcomes. This study represents the first application of I-SEE in a cohort of patients with EoE treated with BOT, the first-line pharmacologic therapy in Europe.
Methods:
We retrospectively analyzed 109 consecutive adults with EoE treated with BOTs for 52 weeks. I-SEE was calculated at baseline (T0), after 12-week induction (T1), and after 1-year maintenance (T2). Associations between I-SEE, baseline characteristics, disease activity, and the risk of dilation were explored.
Results:
At baseline, 28%, 54%, and 17% of patients had mild, moderate, and severe I-SEE, respectively. Higher I-SEE severity was associated with the fibrostenotic phenotype, prior dilation, and food impaction. After induction, 97% achieved a histologic response, and the median I-SEE significantly decreased (P = .001). Improvements were sustained at 1 year, with 70% maintaining histologic remission (P < .001). During maintenance, I-SEE correlated with symptom burden, endoscopic activity, and peak eosinophil count (P = .001), and inversely with histologic remission. The baseline I-SEE score did not predict the loss of response during maintenance. Although higher baseline I-SEE was associated with dilation risk in univariable analysis (OR, 1.11; P = .014), this association was attenuated after adjustment for the fibrostenotic phenotype.
Conclusions:
In patients with BOT-treated EoE, I-SEE reflects multidimensional disease control over time. Higher baseline severity identifies patients with lower response rate to BOT induction and with increased risk of structural complications, supporting early combined medical and endoscopic management.
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