New Index Aims to Help Clinicians Gauge Severity of EoE Cases

A multidisciplinary team of adult and pediatric eosinophilic esophagitis (EoE) experts has unveiled a new scoring system they say will make it easier for clinicians to guide patient treatment in a meaningful and consistent way.

The Index of Severity for Eosinophilic Esophagitis (I-SEE) is intended for use in routine clinical visits. A detailed description of the index was published in Gastroenterology.

The study authors said the processes used to diagnose and track EoE have improved greatly over the past 30 years, and those efforts have led to improvements in treatment.

“Despite these advances, important knowledge gaps about EoE remain,” they wrote. “One area of note relates to variability in practice patterns and how to monitor the clinical course or natural history of a patient during follow-up in the office setting.”

Initially, the authors said, this variability was due largely to a lack of knowledge about the disease, its course, and the effects of treatment. Yet, even as the research base has improved, the medical community has not yet synthesized that existing knowledge into a comprehensive set of guidance to risk-stratify people with EoE, they said.

To help change that, a group of EoE researchers and non-EoE allergy immunology and gastroenterology experts were recruited and divided into 3 teams to review the existing scientific literature related to EoE. A steering committee then met, with the goal of coming to a consensus around the key features of severity in EoE and then creating a system by which to categorize those features of severity.

The resulting scoring system has 3 domains: symptoms and complications, inflammatory features, and fibrostenotic features. Patients are scored based on these domains, with different symptoms or features assigned different point values. Patients with a low score (0-6) are considered to have mild disease, those with scores between 7 and 14 are considered to have moderate disease, and people with scores of 15 or higher are considered to have severe EoE. The authors said the scale is designed to be compatible with routine clinic visits.

Some features, such as esophageal perforation and malnutrition, are assigned 15 points and automatically qualify a patient as having severe EoE.

The investigators said the new scoring system is important because it can help clinicians understand and identify the most important factors related to disease severity, as well as facilitate better communication with patients and colleagues since there will be a clearly defined common terminology.

“Longer-term aims include helping standardize practice for treatments and monitoring based on disease severity similar to the asthma model, with the recognition that additional data will be required for full realization and to assess the index's reliability and reproducibility,” they wrote.

The investigators added that future clinical trials need to evaluate the index’s performance, including how well it responds to changes in patients’ conditions.

“Ultimately, assessing, tracking, and managing disease activity based on severity could provide meaningful improvements in patient management, as well as align research and regulator endpoints,” they concluded.

Reference

Dellon ES, Khoury P, Muir AB, et al. A clinical severity index for eosinophilic esophagitis: development, consensus, and future directions. Gastroenterology. 2022;163(1):59-76. doi:10.1053/j.gastro.2022.03.025