Gaia Pellegatta, Francesca Paola Giugliano, Valeria Poletti, Giacomo Marcozzi, Evan S Dellon, Giovanni Nicita, Lorenzo Petronio, Beatrice Belli, Valentina Baldaccini, Alba Drago, Davide Massimi, Marco Spadaccini, Roberta Maselli, Cesare Hassan, Alessandro Repici
In BOT-treated EoE, I-SEE reflects multidimensional disease control over time. Higher baseline severity identifies patients with lower response rate to BOT induction and with increased risk of structural complications, supporting early combined medical and endoscopic management.
BACKGROUND & AIMS: The Index of Severity for Eosinophilic Esophagitis (I-SEE) is a composite tool used to stratify patients with eosinophilic esophagitis (EoE) according to severity. We assessed longitudinal changes in I-SEE scores in patients treated with budesonide orodispersible tablets (BOT) during induction and maintenance and its association with clinical outcomes. This study represents the first application of I-SEE in a cohort of EoE patients treated with BOT, the first-line pharmacological therapy in Europe.
METHODS: We retrospectively analyzed 109 consecutive EoE adults treated with BOT for 52 weeks. I-SEE was calculated at baseline (T0), after 12-week induction (T1), and after 1-year maintenance (T2). Associations between I-SEE, baseline characteristics, disease activity and risk of dilation were explored.
RESULTS: At baseline, 28%, 54%, and 17% of patients had mild, moderate, and severe I-SEE, respectively. Higher I-SEE severity was associated with fibrostenotic phenotype, prior dilation, and food impaction. After induction, 97% achieved histologic response and median I-SEE significantly decreased (P=.001). Improvements were sustained at 1 year, with 70% maintaining histologic remission (P<.001). During maintenance, I-SEE correlated with symptom burden, endoscopic activity, and peak eosinophil count (P=.001), and inversely with histologic remission. Baseline I-SEE score did not predict loss of response during maintenance. Although higher baseline I-SEE was associated with dilation risk in univariable analysis (OR, 1.11; P=.014), this association was attenuated after adjustment for fibrostenotic phenotype.
CONCLUSIONS: In BOT-treated EoE, I-SEE reflects multidimensional disease control over time. Higher baseline severity identifies patients with lower response rate to BOT induction and with increased risk of structural complications, supporting early combined medical and endoscopic management.