The index of severity for eosinophilic esophagitis reflects treatment response in children and associates with outcome variables

TL;DR

A severity index for eosinophilic esophagitis in children shows treatment response and predicts the need for multiple therapies.

Contribution

The I-SEE index is validated as a sensitive tool for tracking treatment response and predicting treatment complexity in pediatric EoE.

Findings

I-SEE scores significantly decreased after treatment, especially in children with histologic response.

Higher baseline I-SEE scores correlate with the need for multiple or combined therapies.

53% of children had inactive disease at last endoscopy, indicating effective treatment over time.

Abstract

We aimed to categorize the severity of eosinophilic esophagitis using the recently developed Index of Severity of Eosinophilic Esophagitis (I-SEE), to assess the longitudinal response to treatment, and to correlate baseline severity with outcome variables. A retrospective analysis of a prospectively enrolled cohort of children at two centers was performed. I-SEE was calculated at diagnosis, at the second endoscopy after initial treatment, and at the last endoscopy over a mean of 35 months. We analyzed clinical, endoscopic, and histologic characteristics at baseline by disease severity, examined the change in severity at the second and last endoscopy, and evaluated the association of baseline disease severity with treatment variables. Of 95 children meeting inclusion criteria, 35%, 63%, and 2% had mild, moderate, and severe I-SEE scores, respectively, at baseline. Between baseline and the second endoscopy, the median I-SEE decreased from 7 (7–8) to 2 (0–5) (p < 0.001), and to 0 (0–3) at last endoscopy, with 53% of patients having inactive and 47% having mild scores (p < 0.001). Patients with histologic response at the second and final endoscopy had lower I-SEE scores than non-responders (p < 0.001). A higher baseline I-SEE score was associated with increased odds of receiving 2 or more treatments or combined therapy (OR 95% CI 1.28 (1.03–1.59) and (1.18 (1.04–1.39), respectively).

Conclusions: The I-SEE score reflects longitudinal treatment response in children with EoE. Patients with higher baseline I-SEE may be at higher risk of requiring more than one treatment, sequentially or in combination.

What is Known:• Eosinophilic esophagitis is a heterogenous disease with different degrees of severity.• The recently developed index of severity of eosinophilic esophagitis (I-SEE) incorporates frequency of symptoms, complications, and inflammatory and fibrostenotic findings and has shown to be a sensitive tool to change with treatment in a pediatric cohort.What is New:• We confirmed the sensitivity of the index, with a significant decrease in the score with treatment, with the decrease being more pronounced in children with histologic response.• A higher initial severity score was associated with the need for more treatments, sequentially or in combination.

What is Known:

• Eosinophilic esophagitis is a heterogenous disease with different degrees of severity.

• The recently developed index of severity of eosinophilic esophagitis (I-SEE) incorporates frequency of symptoms, complications, and inflammatory and fibrostenotic findings and has shown to be a sensitive tool to change with treatment in a pediatric cohort.

What is New:

• We confirmed the sensitivity of the index, with a significant decrease in the score with treatment, with the decrease being more pronounced in children with histologic response.

• A higher initial severity score was associated with the need for more treatments, sequentially or in combination.

The online version contains supplementary material available at 10.1007/s00431-025-06159-9.

Figures