Eosinophilic Esophagitis Endoscopic Reference Score (EREFS)
Standardised endoscopic scoring system for eosinophilic oesophagitis (EoE). Assesses 5 endoscopic features to grade severity and monitor treatment response.
Score interpretation
→ EREFS 0: No endoscopic features of EoE. If histological concern remains, biopsies still indicated (EoE can be endoscopically normal). Review symptoms.
→ EREFS 1–4: Mild endoscopic EoE features. Take biopsies (2–4 from distal + 2–4 from proximal oesophagus). Initiate proton pump inhibitor (PPI) therapy or swallowed topical corticosteroid (fluticasone/budesonide). Dietary assessment (6-food elimination diet).
→ EREFS 5–9: Significant EoE burden. Biopsies essential. Swallowed topical corticosteroid; PPI; dietary therapy. If stricture present, consider oesophageal dilation (after medical treatment). Biologic therapy (dupilumab) if refractory.
Interpretation bands for the EREFS. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.