Worsening disease severity as measured by I-SEE associates with decreased treatment response to topical steroids in eosinophilic esophagitis patients.

Background And Aims: The index of severity for eosinophilic esophagitis (I-SEE) grades eosinophilic esophagitis (EoE) severity across several domains. We assessed associations between EoE features and severity by I-SEE at diagnosis, and baseline I-SEE and outcomes following topical corticosteroids (tCS).

Methods: We conducted a retrospective cohort study of newly diagnosed EoE patients. Data were extracted to complete I-SEE at diagnosis. Disease activity was categorized as mild (I-SEE 1-6), moderate (7-14), or severe (≥15). We compared baseline characteristics by I-SEE category. We assessed if baseline I-SEE associated with treatment response in patients treated with tCS.

Results: Of 1312 patients, there were 657 (50%), 461 (35%), and 194 (15%) with mild, moderate, and severe disease by I-SEE. Baseline scores were similar for children (8.5±6.6) and adults (8.8±6.5) (p=0.37). Compared with mild or moderate disease, patients with severe disease were younger (23.8±19.8 years severe vs. 28.0±19.7 mild vs. 30.3±17.0 moderate; p<0.001), had lower BMI (21.6±7.1 vs. 24.4±7.0 vs. 25.7±6.8; p<0.001), and longer symptom length preceding diagnosis (9.3±10.5 years vs. 5.9±7.5 vs. 7.2±7.9; p<0.001). Baseline category associated with tCS response with severe patients less likely to have histologic response (49% vs. 55% vs. 64%; p=0.03 for <15 eos/hpf) and symptomatic responses, while also having the highest post-treatment EREFS scores.

Conclusions: I-SEE correlated with baseline features in a large EoE cohort, performed similarly in children and adults, and associated with post-treatment responses to tCS. These data support that I-SEE provides prognostic data and suggest that severe disease may benefit from intensive upfront management.