CORRELATION OF PEESS AND EREFS SCORES WITH HISTOLOGICAL ACTIVITY IN CHILDREN WITH EOSINOPHILIC OESOPHAGITIS (EOE)

IntroductionManagement of children with EoE is hampered by lack of reliable biomarkers. Although the Paediatric Eosinophilic Esophagitis Symptom Score (PEESS v2.0) has been validated as a marker for clinical activity in children and the Endoscopic Reference Score (EREFS) in adults, their use for clinical application has not been evaluated in children in the UK. Aims of this pilot study were: - Correlation of clinical activity (PEESS) with endoscopic grading (EREFS) and standard oesophageal histology (i) Feasibility in clinical practice.MethodsRetrospective review of a single consultant’s cohort of children with EoE (n=13) over 18 months (2019-20) providing n=19 assessments. PEESSv2.0 comprises 20 questions about symptom frequency and severity in domains dysphagia, reflux, nausea/vomiting, and pain generating scores from 0-4. EREFS depicts endoscopic EoE features (oedema, rings, furrowing, exudate, stricture) into a grading score of severity. Pearson’s correlation test was used to indicate significance (p<0.05).Results84.6% of children were male with a mean age of 13.7 years (8.7-17.4yr). In 47.3% (9/19) histologically active EoE [≥15 eosinophils per high power field (eos/hpf)] was found. Mean peak eos/hpf were 4.7 (0-35) in proximal, 14.9 (0-100) in mid and 20.8 (0-80) in distal oesophagus. Mean PEESS score was 20 (mild) and IQR 0-31.5 (range 0-68), indicating mild to moderate activity. There was positive correlation of PEESS scores with the density of eosinophils in the mid (p=0.004) and distal (p=0.0009) oesophagus, but not in proximal (p= 0.23). Mean EREFS score was 1.4 (range 0-3), with furrowing and micro abscess being the most common findings. The correlation of EREFS with PEESS was not significant (p=0.43). Treatment at time of assessment consisted in 63% (12/19) of children of oral viscous budesonide, 21% (4/19) of PPI, 11% (2/19) of elimination diet (ED), and 5% (1/19) of combination therapy.ConclusionIn our pilot study, routine use of PEESS in clinical settings was practical, feasible, and helped to evaluate more objectively efficacy of treatment. Similar to a study in the US, we confirmed a correlation of histologic and clinical activity (PEESS) of EoE in children in the UK. Endoscopic EREFS scores may be helpful to assess longitudinally disease activity and mucosal alternations in patients with EoE. If applied consistently, these scores can be easily applied to monitor disease activity, provide guidance on timing and frequency of endoscopic reassessment, indicate need for treatment escalation, and may help to recognise earlier beginning signs of complications.