Worsening Disease Severity as Measured by I-SEE Associates With Decreased Treatment Response to Topical Steroids in Eosinophilic Esophagitis Patients.

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology Pub Date : 2025-03-10 DOI:10.1016/j.cgh.2025.01.015

Craig C Reed, Sean S LaFata, Timothy S Gee, Hannah L Thel, Brenderia A Cameron, Angela Z Xue, Akshatha Kiran, Adolfo A Ocampo, Justin McCallen, Christopher J Lee, Stephanie A Borinsky, Walker D Redd, Trevor S Barlowe, Rayan N Kaakati, Cary C Cotton, Swathi Eluri, Evan S Dellon

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引用次数: 0

Abstract

Background & 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 the I-SEE at diagnosis. Disease activity was categorized as mild (I-SEE 1-6), moderate (I-SEE 7-14), or severe (I-SEE ≥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, respectively. Baseline scores were similar for children (8.5 ± 6.6) and adults (8.8 ± 6.5) (P = .37). Compared with mild or moderate disease, patients with severe disease were younger (23.8 ± 19.8 years for severe vs 28.0 ± 19.7 years for mild vs 30.3 ± 17.0 years for moderate; P < .001), had lower body mass index (21.6 ± 7.1 kg/m² vs 24.4 ± 7.0 kg/m² vs 25.7 ± 6.8 kg/m²; P < .001), and had longer symptom length preceding diagnosis (9.3 ± 10.5 years vs 5.9 ± 7.5 years vs 7.2 ± 7.9 years; P < .001). The baseline category associated with tCS response, with severe patients less likely to have histologic response (49% vs 55% vs 64%; P = .03 for <15 eosinophils per high-power field) and symptomatic responses, while also having the highest post-treatment eosinophilic esophagitis endoscopic reference 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.

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来源期刊

Clinical Gastroenterology and Hepatology 医学-胃肠肝病学

CiteScore

16.90

自引率

4.80%

发文量

903

审稿时长

22 days

期刊介绍： Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion. As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.