Index of Severity for Eosinophilic Oesophagitis (I-SEE)
Comprehensive index combining histological (eosinophil count) and endoscopic (EREFS) features to assess disease severity in eosinophilic oesophagitis (EoE). Validated for monitoring treatment response.
Score interpretation
I-SEE 0-2 -- mild EoE activity; treatment response assessment
→ EoE management: if on treatment and score < 15 eos/HPF: histological remission achieved; continue maintenance (low-dose PPI or swallowed topical corticosteroid -- budesonide orodispersible tablet 0.5-1 mg BD [ORBIT-2, GEAR trials] or fluticasone inhaler 440 mcg BD swallowed without spacer); dietary therapy: six-food elimination diet (SFED) or targeted elimination based on allergy testing; step-down therapy protocol once remission achieved; monitor symptoms (DySSO symptom score); surveillance endoscopy 1-2 years.
I-SEE 3-6 -- moderate active EoE; treatment escalation likely needed
→ EoE treatment escalation: topical corticosteroid: budesonide orodispersible tablet (BOT) 1 mg BD (licensed EU/UK -- LUCENT-1 and -2 trials); fluticasone 880 mcg BD swallowed; PPI 40 mg BD (PPI-responsive EoE); dietary therapy: SFED (dairy, wheat, egg, legumes, nuts, seafood elimination) -- 70% response; biologic: dupilumab 300 mg every 2 weeks (FDA-approved, NICE review ongoing -- EoE approved indication; TRAMGO/STAGE trials); allergist review for aeroallergen/food sensitisation; oesophageal dilatation if stricture present (savary or pneumatic dilatation -- safe in EoE, mucosal tear is expected); gastroenterology specialist follow-up.
I-SEE 7-11 -- severe active EoE; requires aggressive treatment and multidisciplinary management
→ Urgent gastroenterology/EoE specialist review; start dupilumab if not contraindicated (most effective treatment in severe EoE -- achieves both histological and endoscopic remission); oesophageal dilatation for symptomatic stricture (food impaction risk -- first ensure inflammation controlled before repeated dilatation); topical steroids at higher dose; strict elimination diet trial; food impaction management protocol; safety counselling: soft food diet, chew thoroughly, avoid bolus food triggers; consider nasogastric feeding if severe dysphagia and nutritional failure; emergency endoscopy pathway for food bolus impaction; allergology referral for comprehensive sensitisation assessment; registered dietitian for dietary management.
Interpretation bands for the I-SEE EoE. Apply clinical judgement and local guidance.
References
- Warners MJ et al. The esophageal string test: a novel, minimally invasive method measures mucosal inflammation in eosinophilic esophagitis. Gut. 2017;66(1):59-66.
- Dellon ES et al. Updated international consensus diagnostic criteria for eosinophilic esophagitis: proceedings of the AGREE conference. Gastroenterology. 2018;155(4):1022-1033.
Related
Curated clinical cross-links plus same-class fallbacks.
- Dupilumab · Biologic (IL-4 / IL-13 receptor antagonist)
- Methotrexate (Dermatology — Psoriasis) · Disease-Modifying Antirheumatic / Immunosuppressant
- Dupilumab (CRSwNP) · IL-4Rα Inhibitor (Anti-IL-4/IL-13)
- Acetazolamide (Ménière's Disease) · Carbonic Anhydrase Inhibitor (Diuretic)
- Zinc acetate · Zinc salt (Wilson's disease)
- Sulfasalazine · Aminosalicylate / Disease-Modifying Antirheumatic Drug (DMARD)
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.