I-SEE, Index of Severity for EoE

Aggregates symptoms and complications, inflammatory features, and fibrostenotic features into a single EoE severity score. Complements, does not replace, the peak eosinophil count and EREFS. Several features (perforation, malnutrition, a non-traversable stricture) score 15 and by themselves make the disease severe.

Evidence tier: Expert consensus. The severity strata are consensus cut-offs from an expert panel, not values derived and locked in a validation cohort, and the score is recent. Use it to structure and track an assessment, not as a hard treatment threshold.

Formula / logic

I-SEE = sum of three domains. Symptoms & complications: symptoms (weekly +1 / daily +2 / multiple-daily or functionally disrupting +4), food impaction (+2 adult / +4 child), hospitalization +4, perforation +15, persistent malnutrition +15, persistent inflammation needing intensive therapy +15. Inflammatory: endoscopy (localized +1 / diffuse +2), peak eosinophils (15-60 +1 / >60 +2). Fibrostenotic: endoscopy (passes easily +1 / snug or dilation +2 / non-traversable or repeated dilations +15), histology (BZH or LPF +2). Strata: 0 inactive; 1-6 mild; 7-14 moderate; >=15 severe.

Interpretation

I-SEE is a single number for communicating and tracking EoE severity over time, not a diagnostic test. It sits alongside the two established component measures rather than replacing them: the peak eosinophil count for histologic activity, and EREFS for the endoscopic picture. Its most useful property is that several genuinely severe features, perforation, malnutrition, a stricture that will not admit a standard endoscope, or disease that needs elemental formula or systemic immunosuppression, each score 15, so any one of them classifies the disease as severe regardless of the rest.

Evidence & citations

Clinician decision support. Verify against the cited source. Not a substitute for clinical judgment. 100% on-device; no patient data is stored or transmitted.