Histologic scoring system as good as peak eosinophil count in eosinophilic esophagitis

The eosinophilic esophagitis (EoE) histologic scoring system (HSS) displays high responsiveness and similar performance to peak eosinophil count (PEC), reports a study. In addition, EoE-HSS is more highly associated with changes in overall histologic activity.

A team of investigators obtained histopathology slides from EoE patients at baseline and after 8 weeks of treatment with swallowed topical budesonide or elimination diet. Two blinded gastrointestinal pathologists scored biopsies on the EoE-HSS, PEC, and 100-mm visual analogue scale (VAS) of overall histologic severity. Change was defined as an improvement by ≥0.5 SD in baseline VAS.

The investigators quantified responsiveness using the standardized effect size (SES) and the probability that the index distinguishes a patient with improvement from a patient without improvement, which is the area under the receiver operating characteristic curve (AUC). They also evaluated longitudinal validity using Pearson correlations between changes in EoE-HSS and both PEC and VAS.

The EoE-HSS grade (SES, 2.18, 95 percent confidence interval [CI], 1.46‒2.88; AUC, 0.73, 95 percent CI, 0.57‒0.84) and stage (SES, 2.07, 95 percent CI, 1.37‒2.77; AUC, 0.73, 95 percent CI, 0.58‒0.84) were highly responsive and performed similarly to PEC (SES, 1.44, 95 percent CI, 0.80‒2.07; AUC, 0.73, 95 percent CI, 0.58‒0.84).

In addition, the EoE-HSS grade and stage had a stronger association with changes in VAS (grade: 0.92, 95 percent CI, 0.86‒0.95; stage: 0.89, 95 percent CI, 0.81‒0.94) than with changes in PEC (grade: 0.74, 95 percent CI, 0.58‒0.85; stage: 0.66, 95 percent CI, 0.47‒0.80).