Eosinophilic Esophagitis Severity Index Linked to Clinical Features, Treatment Response

Eosinophilic esophagitis
Researchers investigated the relationship between eosinophilic esophagitis at the time of diagnosis and disease severity, and the change in disease before and after treatment.

The eosinophilic esophagitis (EoE) severity index correlates with many clinical features at diagnosis, and severity improves with topical steroid treatment, according to study results presented at Digestive Disease Week (DDW), held from May 21 to 24, 2022, in San Diego, California, and virtually.

Investigators conducted a secondary analysis of data from an 8-week randomized trial that compared 2 topical steroid formulations for the treatment of patients with newly diagnosed EoE. They used data from the trial and medical records to populate features of the new severity index at baseline and after treatment, which included symptom frequency, food impaction requiring an emergency department visit or endoscopy, EoE-related hospitalization, esophageal perforation, and malnutrition, as well as selected inflammatory, fibrotic endoscopic, and histologic features.

The researchers calculated an overall severity score for each time point, and patients were grouped as mild (1-6 points), moderate (7-14 points), severe (at least 15 points), or inactive (0 points). They analyzed clinical, endoscopic, and histologic features at baseline according to disease severity and assessed changes in severity before and after treatment.

A total of 111 patients were randomized (mean age, 39 years; 67% men; 96% White). Of these patients, 20 (18%) were classified as mild, 75 (68%) as moderate, and 16 (14%) as severe at baseline according to the new index.

Increasing severity was associated with a lower body mass index (30 kg/m2 for mild, 27 kg/m2 for moderate, and 24 kg/m2 for severe; P =.01), longer duration of dysphagia symptoms before diagnosis (9 years for mild, 9 years for moderate, and 20 years for severe; P <.001), increasing EoE endoscopic reference score (3 for mild, 5 for moderate, and 6 for severe; P <.001), and decreasing esophageal diameter (15 mm for mild, 13 mm for moderate, and 10 mm for severe; P <.001).

Participants’ mean severity score decreased after treatment (11 vs 4; P <.001), and histologic responders had lower scores compared with nonresponders (2 vs 9; P <.001). Severity category and individual features of the index also improved with treatment. Baseline severity predicted the need for esophageal dilation at follow-up (mild 5%, moderate 57%, and severe 94%; P <.001), but it did not predict histologic response.

The study authors concluded, “Additional investigations into this index with other datasets are required to confirm its utility and determine how severity should impact treatment algorithms.”


Cotton CC, Moist SE, Mcgee SJ, Furuta G, Aceves SS, Dellon ES. A newly proposed severity index for eosinophilic esophagitis is associated with baseline clinical features and successful treatment response: first assessment in an independent randomized trial dataset. Presented at: DDW 2022; May 21-24, 2022; San Diego, CA. Presentation Su1170.