gi-hepatology

Index of Severity for Eosinophilic Oesophagitis (I-SEE)

Index of Severity for Eosinophilic Oesophagitis (I-SEE; Dellon 2022): expert-consensus severity index for adults and children across symptoms and complications, inflammatory features (endoscopy and histology) and fibrostenotic features.

Symptom frequency (since the last visit)*

Food impaction needing an ER visit or endoscopy*

Hospitalisation due to EoE (+4)

Yes

Oesophageal perforation (+15)

Yes

Malnutrition — body mass < 5th centile or decreased growth trajectory (+15)

Yes

Persistent inflammation needing elemental formula, systemic corticosteroids or immunomodulators (+15)

Yes

Endoscopy: oedema, furrows and/or exudates*

Peak eosinophil count*

Endoscopy: rings and/or strictures*

Histology: basal zone hyperplasia or lamina propria fibrosis (or dyskeratotic cells / surface epithelial alteration if no lamina propria)*

Score interpretation

Inactive EoE (I-SEE 0) 0

No active features scored.

→ Continue maintenance therapy; monitor symptoms; specialist-led endoscopic surveillance.

Mild Active EoE (I-SEE 1–6) 1–6

I-SEE 1–6 — mild active EoE.

→ EoE management: if on treatment and score < 15 eos/HPF: histological remission achieved; continue maintenance (low-dose PPI or swallowed topical corticosteroid -- adults: budesonide orodispersible tablet 0.5-1 mg BD 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. Children: use a children's formulary.

Moderate Active EoE (I-SEE 7–14) 7–14

I-SEE 7–14 — moderate active EoE.

→ EoE treatment escalation (adult doses): topical corticosteroid: budesonide orodispersible tablet (BOT) 1 mg BD (licensed EU/UK); 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 week (FDA-approved for EoE; 40 kg or more); 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. Children: use a children's formulary.

Severe Active EoE (I-SEE ≥ 15) 15–78

I-SEE 15 or more — severe active EoE.

→ 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

Dellon ES, Khoury P, Muir AB, et al. A Clinical Severity Index for Eosinophilic Esophagitis: Development, Consensus, and Future Directions. Gastroenterology. 2022;163(1):59–76.
Dellon ES et al. Updated international consensus diagnostic criteria for eosinophilic esophagitis: proceedings of the AGREE conference. Gastroenterology. 2018;155(4):1022-1033.

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

Related