The Index of Severity for Eosinophilic Esophagitis (I-SEE) is gaining strong support as a standardized tool for assessing and managing EoE, a chronic allergic inflammatory condition of the esophagus.
Developed with AGA facilitation by an international expert team, I-SEE provides a single composite score that classifies EoE into four categories - inactive, mild, moderate, or severe - by integrating three key domains:
1. Symptoms and complications (e.g., frequency of dysphagia, food impactions, malnutrition)
2. Inflammatory features (e.g., eosinophil counts in biopsies)
3. Fibrostenotic features (e.g., strictures, need for dilation)
This approach moves beyond relying solely on eosinophil counts, incorporating symptom burden and remodeling signs for a more complete picture of disease activity.
I-SEE correlates with clinical features like lower BMI, longer symptom duration, narrower esophageal diameter, and molecular markers of severity.
Higher baseline I-SEE scores predict poorer responses to treatments such as topical corticosteroids (with reduced histologic and symptom improvements in more severe cases) and dupilumab (where each unit increase in pre-treatment score links to lower histologic response rates).
It forecasts outcomes like the need for esophageal dilation.
Overall, I-SEE represents a major step forward in standardizing EoE assessment, helping clinicians better stratify patients, predict treatment success, and personalize care for better long-term outcomes.