P0430 - Using Index of Severity for EoE to Guide Treatment for Patients With Eosinophilic Esophagitis

Zhuo Yu, DO¹, Marta Arjonilla, MD², Farah Monzur, MD, FACG^1
1Stony Brook University Hospital, Stony Brook, NY; ²Stony Brook University, Stony Brook, NY

Introduction: Eosinophilic esophagitis (EoE) is an inflammatory condition triggered by food antigens in sensitive patients. Recognized as one of the major causes of dysphagia, EoE has become increasingly prevalent in the recent years. In light of this, the Index of Severity for EoE (I-SEE) was published in 2022 by the AGA as a simple tool for grading the severity of EoE, incorporating both clinical and pathological features.

Methods: We conducted a single-center observational study of 102 patients who underwent EGD and were diagnosed with EoE from 1/1/2018 to 4/1/2023. We recorded demographics, clinical features, EGD results, and treatments received for each patient, and calculated the I-SEE score based on the above. Patients were classified as mild (1-6 points), moderate (7-14 points), or severe (≥ 15 points) per I-SEE. We wanted to determine the relationship between patient characteristics and I-SEE severity, and assess how the I-SEE score could impact the treatment plan.

Results: Of the 102 subjects included in this study, 30% were female and 70% were male with a mean age of 38. There were 92.2% White, 2% Asians, 2.9% African American, and the rest unspecified. Within the study, 48 patients (47%) were classified as mild, 50 (49%) as moderate, and 4 (4%) as severe based on I-SEE. Increasing severity was associated with lower BMI (27.1 for mild, 26.9 for moderate and 24.8 for severe; P=0.48); younger age at initial diagnosis (average age of 35 for mild, 29 for moderated and 27 for severe; P=0.1083); and higher EFERS score on EGD (1.3 for mild, 3.0 for moderate and 3.1 for severe; P=0.0087). Within the 48 subjects graded as mild, 47 (98%) required proton pump inhibitor (PPI), 18 (37.5%) needed topical steroids, and none were started on biologics. Among the 50 subjects graded as moderate, all 50 (100%) were started on PPI, 37 (74%) were started on topical steroid and 4 (8%) were started on biologics Dupilumab for disease control. Among the 4 subjects graded as severe, all 4 (100%) of them were on PPI and topical steroid, and 2 (50%) were started on Dupilumab.

Discussion: The new I-SEE scoring system for EoE incorporates clinical symptoms, inflammatory features and pathology to better characterize the degree of disease severity. Our study suggests that I-SEE score may correspond with management algorithm, with increase in severity of I-SEE correlating with escalation of treatment. However, given its recent development, further research is needed for I-SEE utilization in clinical practice.




Disclosures:


Zhuo Yu, DO¹, Marta Arjonilla, MD², Farah Monzur, MD, FACG¹. P0430 - Using Index of Severity for EoE to Guide Treatment for Patients With Eosinophilic Esophagitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.