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The following is a summary of “Worsening disease severity as measured by I-SEE associates with decreased treatment response to topical steroids in eosinophilic esophagitis patients,” published in the March 2025 issue of Clinical Gastroenterology and Hepatology by Reed et al.

The Index of Severity for Eosinophilic Esophagitis (I-SEE) is a comprehensive grading system designed to assess disease severity across multiple domains. This study aimed to evaluate the association between various clinical, endoscopic, and histologic features of eosinophilic esophagitis (EoE) at diagnosis and I-SEE severity scores, as well as to determine the predictive value of baseline I-SEE scores for treatment outcomes following topical corticosteroid (tCS) therapy. Researchers conducted a retrospective cohort study including newly diagnosed patients with EoE, extracting data to assign I-SEE scores at diagnosis. 

Disease severity was categorized into mild (I-SEE 1–6), moderate (I-SEE 7–14), and severe (I-SEE ≥15). Baseline characteristics were compared across these severity categories, and the association between initial I-SEE scores and subsequent treatment response to tCS was analyzed. Among 1,312 patients included in the study, 657 (50%) were classified as mild, 461 (35%) as moderate, and 194 (15%) as severe based on I-SEE scores. Baseline I-SEE scores were comparable between children (8.5 ± 6.6) and adults (8.8 ± 6.5; p = 0.37). Patients with severe disease were significantly younger (23.8 ± 19.8 years vs. 28.0 ± 19.7 years for mild vs. 30.3 ± 17.0 years for moderate; p < 0.001), had a lower body mass index (BMI: 21.6 ± 7.1 vs. 24.4 ± 7.0 vs. 25.7 ± 6.8; p < 0.001), and exhibited a longer duration of symptoms before diagnosis (9.3 ± 10.5 years vs. 5.9 ± 7.5 years vs. 7.2 ± 7.9 years; p < 0.001). 

The baseline I-SEE category was significantly associated with treatment response, as patients with severe disease demonstrated lower rates of histologic remission following tCS therapy (49% vs. 55% vs. 64%; p = 0.03 for <15 eos/hpf) and reduced symptomatic improvement. Additionally, those with severe disease exhibited the highest post-treatment Endoscopic Reference Score (EREFS), indicating persistent endoscopic abnormalities. These findings suggest that the I-SEE scoring system not only correlates with baseline disease characteristics but also serves as a valuable prognostic tool for treatment response. The study underscores the importance of considering disease severity at diagnosis to guide therapeutic decisions, particularly for patients with severe disease, who may require more intensive and tailored management strategies.

Source: cghjournal.org/article/S1542-3565(25)00157-0/abstract