Evan S Dellon1, Paneez Khoury2, Amanda B Muir3, Chris A Liacouras4, Ekaterina Safroneeva5, Dan Atkins6, Margaret H Collins7, Nirmala Gonsalves8, Gary W Falk9, Jonathan M Spergel10, Ikuo Hirano8, Mirna Chehade11, Alain M Schoepfer12, Calies Menard-Katcher13, David A Katzka14, Peter A Bonis15, Albert J Bredenoord16, Bob Geng17, Elizabeth T Jensen18, Robert D Pesek19, Paul Feuerstadt20, Sandeep K Gupta21, Alfredo J Lucendo22, Robert M Genta23, Girish Hiremath24, Emily C McGowan25, Fouad J Moawad26, Kathryn A Peterson27, Marc E Rothenberg28, Alex Straumann29, Glenn T Furuta30, Seema S Aceves31. 1. Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill. Electronic address: edellon@med.unc.edu. 2. Human Eosinophil Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda. 3. Division of Gastroenterology, Hepatology, and Nutrition, Perelman School of Medicine, University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Philadelphia. 4. Division of Gastroenterology, Hepatology, and Nutrition, Perelman School of Medicine, University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Philadelphia; Center for Pediatric Eosinophilic Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia. 5. Institute of Social and Preventive Medicine, University of Bern, Bern. 6. Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora; Children's Hospital Colorado, Aurora. 7. Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati; Cincinnati Children's Hospital Medical Center, Cincinnati. 8. Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago. 9. The Children's Hospital of Philadelphia, Philadelphia; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. 10. The Children's Hospital of Philadelphia, Philadelphia; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia. 11. Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York. 12. Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne. 13. Department of Pediatrics, University of Colorado School of Medicine, Aurora; Digestive Health Institute, Children's Hospital Colorado, Aurora. 14. Mayo Clinic, Rochester. 15. Tufts Medical Center, Boston. 16. Department of Gastroenterology, Amsterdam University Medical Center, Amsterdam. 17. University of California San Diego, San Diego; Rady Children's Hospital, San Diego. 18. Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem. 19. Division of Allergy/Immunology, University of Arkansas for Medicine Sciences, Little Rock; Arkansas Children's Hospital, Little Rock. 20. Division of Gastroenterology, Yale-New Haven Hospital, New Haven; Physicians Alliance of Connecticut, Gastroenterology Center, Hamden. 21. Section of Pediatric Gastroenterology/Hepatology/Nutrition, Indiana University School of Medicine, Indianapolis; Riley Hospital for Children, Indianapolis; Community Health Network, Indianapolis. 22. Department of Gastroenterology, Hospital General de Tomelloso, Ciudad Real; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid; Instituto de Investigación Sanitaria La Princesa, Madrid. 23. Baylor College of Medicine, Houston. 24. Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville. 25. Allergy and Clinical Immunology, University of Virginia, Charlottesville. 26. Division of Gastroenterology, Scripps Clinic, La Jolla. 27. Division of Gastroenterology, University of Utah Health, Salt Lake City. 28. Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati. 29. University Hospital Zurich, Zurich. 30. Digestive Health Institute, Children's Hospital Colorado, Aurora; Department of Pediatrics, Gastrointestinal Eosinophilic Diseases Program and Mucosal Inflammation Program, University of Colorado School of Medicine, Aurora. 31. Rady Children's Hospital, San Diego; Division of Allergy, Immunology, University of California-San Diego, San Diego.
Abstract
BACKGROUND & AIMS: Disease activity and severity of eosinophilic esophagitis (EoE) dictate therapeutic options and management, but the decision-making process for determining severity varies among practitioners. To reduce variability in practice patterns and help clinicians monitor the clinical course of the disease in an office setting, we aimed to create an international consensus severity scoring index for EoE. METHODS: A multidisciplinary international group of adult and pediatric EoE researchers and clinicians, as well as non-EoE allergy immunology and gastroenterology experts, formed 3 teams to review the existing literature on histology, endoscopy, and symptoms of EoE in the context of progression and severity. A steering committee convened a 1-day virtual meeting to reach consensus on each team's opinion on salient features of severity across key clinicopathologic domains and distill features that would allow providers to categorize disease severity. RESULTS: Symptom features and complications and inflammatory and fibrostenotic features on both endoscopic and histologic examination were collated into a simplified scoring system-the Index of Severity for Eosinophilic Esophagitis (I-SEE)-that can be completed at routine clinic visits to assess disease severity using a point scale of 0-6 for mild, 7-14 for moderate, and ≥15 for severe EoE. CONCLUSIONS: A multidisciplinary team of experts iteratively created a clinically usable EoE severity scoring system denominated "I-SEE" to guide practitioners in EoE management by standardizing disease components reflecting disease severity beyond eosinophil counts. I-SEE should be validated and refined using data from future clinical trials and routine clinical practice to increase its utilization and functionality.
BACKGROUND & AIMS: Disease activity and severity of eosinophilic esophagitis (EoE) dictate therapeutic options and management, but the decision-making process for determining severity varies among practitioners. To reduce variability in practice patterns and help clinicians monitor the clinical course of the disease in an office setting, we aimed to create an international consensus severity scoring index for EoE. METHODS: A multidisciplinary international group of adult and pediatric EoE researchers and clinicians, as well as non-EoE allergy immunology and gastroenterology experts, formed 3 teams to review the existing literature on histology, endoscopy, and symptoms of EoE in the context of progression and severity. A steering committee convened a 1-day virtual meeting to reach consensus on each team's opinion on salient features of severity across key clinicopathologic domains and distill features that would allow providers to categorize disease severity. RESULTS: Symptom features and complications and inflammatory and fibrostenotic features on both endoscopic and histologic examination were collated into a simplified scoring system-the Index of Severity for Eosinophilic Esophagitis (I-SEE)-that can be completed at routine clinic visits to assess disease severity using a point scale of 0-6 for mild, 7-14 for moderate, and ≥15 for severe EoE. CONCLUSIONS: A multidisciplinary team of experts iteratively created a clinically usable EoE severity scoring system denominated "I-SEE" to guide practitioners in EoE management by standardizing disease components reflecting disease severity beyond eosinophil counts. I-SEE should be validated and refined using data from future clinical trials and routine clinical practice to increase its utilization and functionality.
Authors: Ikuo Hirano; Margaret H Collins; Yehudith Assouline-Dayan; Larry Evans; Sandeep Gupta; Alain M Schoepfer; Alex Straumann; Ekaterina Safroneeva; Michael Grimm; Heather Smith; Cindy-Ann Tompkins; Amy Woo; Robert Peach; Paul Frohna; Sheila Gujrathi; Darryl N Penenberg; Caiyan Li; Gregory J Opiteck; Allan Olson; Richard Aranda; Marc E Rothenberg; Evan S Dellon Journal: Gastroenterology Date: 2018-11-02 Impact factor: 22.682
Authors: Alfredo J Lucendo; Stephan Miehlke; Christoph Schlag; Michael Vieth; Ulrike von Arnim; Javier Molina-Infante; Dirk Hartmann; Albert Jan Bredenoord; Constanza Ciriza de Los Rios; Stefan Schubert; Stefan Brückner; Ahmed Madisch; Jamal Hayat; Jan Tack; Stephen Attwood; Ralph Mueller; Roland Greinwald; Alain Schoepfer; Alex Straumann Journal: Gastroenterology Date: 2019-03-26 Impact factor: 22.682
Authors: Alfredo J Lucendo; Javier Molina-Infante; Ángel Arias; Ulrike von Arnim; Albert J Bredenoord; Christian Bussmann; Jorge Amil Dias; Mogens Bove; Jesús González-Cervera; Helen Larsson; Stephan Miehlke; Alexandra Papadopoulou; Joaquín Rodríguez-Sánchez; Alberto Ravelli; Jukka Ronkainen; Cecilio Santander; Alain M Schoepfer; Martin A Storr; Ingrid Terreehorst; Alex Straumann; Stephen E Attwood Journal: United European Gastroenterol J Date: 2017-01-23 Impact factor: 4.623
Authors: Christopher Ma; Albert J Bredenoord; Evan S Dellon; Jeffrey A Alexander; Luc Biedermann; Malcolm Hogan; Leonardo Guizzetti; Guangyong Zou; David A Katzka; Mirna Chehade; Gary W Falk; Glenn T Furuta; Sandeep K Gupta; Amir F Kagalwalla; Alain M Schoepfer; Stephan Miehlke; Fouad J Moawad; Kathryn Peterson; Nirmala P Gonsalves; Alex Straumann; Joshua B Wechsler; Julie Rémillard; Lisa M Shackelton; Hector S Almonte; Brian G Feagan; Vipul Jairath; Ikuo Hirano Journal: Gastrointest Endosc Date: 2022-02-01 Impact factor: 10.396
Authors: Cary C Cotton; John T Woosley; Susan E Moist; Sarah J McGee; Alina Iuga; Nicholas J Shaheen; Evan S Dellon Journal: Endoscopy Date: 2022-01-11 Impact factor: 9.776
Authors: Ikuo Hirano; Margaret H Collins; David A Katzka; Vincent A Mukkada; Gary W Falk; Robin Morey; Nirav K Desai; Lan Lan; James Williams; Evan S Dellon Journal: Clin Gastroenterol Hepatol Date: 2021-04-19 Impact factor: 13.576
Authors: Ekaterina Safroneeva; Cary C Cotton; Alain M Schoepfer; Marcel Zwahlen; John T Woosley; Evan S Dellon Journal: Am J Gastroenterol Date: 2020-12 Impact factor: 12.045