Applying the Eosinophilic Esophagitis Reference Scores to Different Aged Children

Background & aims: The eosinophilic esophagitis (EoE) endoscopic reference score (EREFS) was developed to analyze adults with EoE and has been successfully applied to a pediatric cohort. The present study compares EREFS scores in younger and older children with EoE.

Methods: The 99 patients were divided among three cohorts: 44 Active EoE (EoE-A); 16 EoE-remission (EoE-R), and 39 controls (esophageal dysfunction but < 15 eos/hpf). The cohorts were then subdivided into two groups: younger (≤ 10 years) and older (> 10 years) that were compared based on the composite and the individual components of their EREFS scores.

Results: EREFS identified active EoE in all children with an AUC of 0.85, in older children with an AUC of 0.90 and in younger children with an AUC of 0.77. Mean EREFS for ≤ 10 years was 1.26 ± 1.19 and 2.71 ± 1.33 for > 10 years (p < 0.01). The three most common findings in our entire EoE-A cohort and in both ages were furrows, edema and exudates. EREFS scores in EoE-A patients had similar specificities (0.88 vs 0.89) and positive predictive values (0.89 vs 0.91) in both ages.

Conclusions: The present investigation confirms the utilization of EREFS scores in Pediatric EoE. Furthermore, EREFS can detect EoE and document response to treatment in both younger and older children. However, EREFS scores predicted EoE in the older children with a higher sensitivity (0.89 vs 0.63) and a higher negative predictive value (0.87 vs 0.59) than was seen in the younger cohort.