Clinical and Molecular Correlates of the Index of Severity for Eosinophilic Esophagitis

Background The Index of Severity for Eosinophilic Esophagitis (I-SEE) is a new expert-defined clinical tool that classifies disease severity of eosinophilic esophagitis (EoE). Objective We aimed to determine whether I-SEE is associated with patient characteristics and/or molecular features of EoE. Methods We analyzed a prospective cohort of patients with EoE from the Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR). Associations between I-SEE and clinical and molecular features (EoE Diagnostic Panel [EDP]) were assessed. Results In 318 patients with chronic EoE (adults 209, children 109), the median total I-SEE score was 7.0, with a higher symptoms and complications score in children than adults (4.0 vs. 1.0; P < .001) and higher inflammatory and fibrostenotic features scores in adults than children (3.0 vs. 1.0 and 3.0 vs. 0.0, respectively; both P < .001). Total I-SEE score had a bimodal distribution with the inactive to moderate categories and severe category. EDP score correlated with total I-SEE score (r = -0.352, P < .001) and both inflammatory and fibrostenotic features scores (r = -0.665, P< .001; r = -0.446, P < .001, respectively), but not with symptoms and complications scores (r = 0.047, P = .408). Molecular severity increased from inactive to mild and moderate, but not severe categories. Longitudinal changes of modified I-SEE scores and inflammatory and fibrostenotic features scores reflected the histologic and molecular activity. Conclusions I-SEE associated with select clinical features across severity categories and with EoE molecular features for non-severe categories, warranting further validation.