Clinical and molecular correlates of the Index of Severity for Eosinophilic Esophagitis - 06/06/24

Doi : 10.1016/j.jaci.2024.04.025

Hiroki Sato, MD, PhD ^a, Evan S. Dellon, MD, MPH ^b, Seema S. Aceves, MD, PhD ^c, Nicoleta C. Arva, MD, PhD ^d, Mirna Chehade, MD, MPH ^e, Margaret H. Collins, MD ^a, Carla M. Davis, MD ^f, Gary W. Falk, MD, MS, MASGE ^g, Glenn T. Furuta, MD ^h, Nirmala P. Gonsalves, MD ⁱ, Sandeep K. Gupta, MD ^j, Ikuo Hirano, MD ⁱ, Girish Hiremath, MD, MPH ^k, David A. Katzka, MD ^l, Paneez Khoury, MD, MHSc ^m, John Leung, MD ⁿ, Paul Menard-Katcher, MD ^o, Robbie Pesek, MD ^p, Kathryn A. Peterson, MD ^q, Maria A. Pletneva, MD, PhD ^q, Jonathan M. Spergel, MD, PhD ^r, Joshua B. Wechsler, MD, MS ^s, Guang-Yu Yang, MD ⁱ, Marc E. Rothenberg, MD, PhD ^a,^t, Tetsuo Shoda, MD, PhD ^a,^t,^⁎
^a Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
^b University of North Carolina, Chapel Hill, NC
^c University of California San Diego School of Medicine, San Diego, Rady Children’s Hospital, San Diego, Calif
^d Nationwide Children’s Hospital, Columbus, Ohio
^e Icahn School of Medicine at Mount Sinai, New York, NY
^f Baylor College of Medicine, Texas Children’s Hospital, Houston, Tex
^g Penn Medicine, Philadelphia, Pa
^h Children’s Hospital Colorado, Aurora, Colo
ⁱ Northwestern University Feinberg School of Medicine, Chicago, Ill
^j University of Alabama at Birmingham, Birmingham, Ala
^k Vanderbilt University Medical Center, Nashville, Tenn
^l Columbia University Irving Medical Center, New York, NY
^m National Institutes of Health, Bethesda, Md
ⁿ Boston Specialists, Boston, Mass
^o University of Colorado Anschutz Medical Campus, Aurora, Colo
^p University of Arkansas for Medical Science, Little Rock, Ark
^q University of Utah Health, Salt Lake City, Utah
^r Children’s Hospital of Philadelphia, Philadelphia, Pa
^s Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Ill
^t University of Cincinnati College of Medicine, Cincinnati, Ohio

^∗Corresponding author: Tetsuo Shoda, MD, PhD, Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine: 3333 Burnet Ave, ML 7028, Cincinnati, OH 45229.Division of Allergy and ImmunologyCincinnati Children’s Hospital Medical CenterDepartment of PediatricsUniversity of Cincinnati College of Medicine: 3333 Burnet AveML 7028CincinnatiOH45229

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Graphical abstract

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Abstract

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, molecular features of EoE, or both.

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 (assessed by an EoE diagnostic panel [EDP]) were assessed.

Results

In 318 patients with chronic EoE (209 adults, 109 children), 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, 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 histologic and molecular activity.

Conclusions

I-SEE score is associated with select clinical features across severity categories and with EoE molecular features for nonsevere categories, warranting further validation.

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Key words : Eosinophilic esophagitis, diagnostic panel, eosinophil, complications, outcome

Abbreviations used : CEGIR, EDP, EGID, EoE, eos/hpf, FDR, IQR, I-SEE, m-I-SEE, OMEGA