The Endoscopic Reference Score shows modest accuracy to predict either clinical or histological activity in adult patients with eosinophilic oesophagitis

Abstract

Summary Background Conflicting results have been recently reported for the accuracy of the Endoscopic Reference Score (EREFS), an standardised endoscopic classification, to predict the histological activity of eosinophilic oesophagitis (EoE). Aim To evaluate the accuracy of the EREFS to predict either histological or clinical activity of EoE. Methods Prospective multicentre study conducted in eight Spanish centres evaluating adult EoE patients, either naïve or after treatment. Symptoms were evaluated before upper endoscopy through the Dysphagia Symptom Score, whereas researchers scored the EREFS immediately after the endoscopic procedure, unaware of the histological outcome. Results One hundred and forty‐five EoE patients undergoing 240 consecutive endoscopic procedures were included. Exudates (P = 0.03), furrows (P = 0.03) and a composite score of inflammatory signs (exudates, furrows and oedema) (P < 0.001) accurately predicted histological activity. Exudates were the only endoscopic sign showing a good correlation with histological outcome after therapy. Furrows and oedema persisted in 50% and 70% of patients despite histological remission. No endoscopic feature exceeded 70% accuracy to predict histological activity. Likewise, no endoscopic finding could adequately predict dysphagia severity. Crepe paper mucosa, diffuse exudates and severe rings correlated with higher symptom scores. Conclusions Endoscopic findings assessed by the Endoscopic Reference Score did not correlate with histological or clinical disease activity in adult EoE patients. Only exudates correlated with peak eosinophil count and histological outcome, whereas furrows and oedema persisted in over half of patients despite histological remission.

Eosinophilic Esophagitis Reference Score Accurately Identifies Disease Activity and Treatment Effects in Children

“…5,6,13 Dellon et al 4 assessed an EREFS inflammatory score, derived by adding the maximum score for edema, exudate, and furrows. We found this score well correlated with eosinophilia in all areas of the esophagus (proximal, mid, and distal), and ROC analysis showed the score accurately distinguished incident EoE from control, and post-treatment active from inactive disease.…”

Diagnosis and Treatment of Eosinophilic Esophagitis

“…34 Other studies have shown weak to modest association between EREFS score and histology findings. 35,36 This discrepancy might be related, in part, to the variable resolution of endoscopic findings with medical therapy, depending on whether the resolution occurs via reductions in inflammation or fibrosis. Endoscopic findings (and symptoms) might also be an important marker of disease activity, regardless of biopsy eosinophil count.…”

Correlation of High-Resolution Manometric Findings with Symptoms of Dysphagia and Endoscopic Features in Adults with Eosinophilic Esophagitis

“…Since EREFS represents a tool to standardize and classify the endoscopic features according to a more IF or FS dominant subtype of EoE [9,25] with good inter-and intra-observer reliability, we correlated EREFS with EoE subtypes. Our findings that the FS type presents with significantly higher EREFS suggest that EoE presents with a variety of mixed endoscopic signs, and a co-existence of IF and fibrotic endoscopic abnormalities [9,25,26] is more often seen than a strictly defined EoE subtype.…”

“…In our study, we found no support for this thesis, as the FS EoE subtype did not correlate with the severity of dysphagia. No single endoscopic feature was significantly associated with the degree of dysphagia; a positive trend toward patients' reported dysphagia was seen for exudates, fixed rings, and crêpe paper mucosa [26] . Our findings question whether the use of a non-validated dysphagia score is adequate to evaluate and grade symptoms in EoE patients.…”