The EoE Scoring Guide

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May 1, 2019 | Crystal Lavey | @crystallavey

You may have noticed your patient appointment guide contained many appointments over a couple of days. During your office visit, did you count how many different people you talked to? While all this activity in a short amount of time can seem overwhelming, each person on the team comes together to help diagnose the severity of your EoE. Here’s a breakdown of each part:

• Symptom Assessment – How are you feeling? How is your swallowing? How much water do you drink with a meal? When was the last time you went out to a restaurant and had chicken or steak? These questions may be asked by the nurse practitioner or physician during your office visit.
• EEsAI – The eosinophilic esophagitis symptom activity index is a questionnaire about how you have/have not eaten certain kinds of foods during recent time periods. Based on your answers, the questionnaire calculates a score. The higher the score you have indicates severity of disease. For example, have you modified how you eat plain white rice in the past week?
• Esophagram – This is essentially an X-ray of your esophagus. The radiologist is looking for reasons why you may be having trouble swallowing, as well as give a preview to what the doctor in the upper endoscopy should look out for. The x-ray can also provide the diameter of your esophagus and detect any narrowing to recommend dilation (stretching) during your upper endoscopy.
• Esophagogastroduendoscopy (EGD) – During your upper endoscopy, the physician uses a camera to look at your esophagus. They are looking for specific traits of EoE called an EREFs score. They will also take tiny pinches of tissue called biopsies for further evaluation.
• EndoFLIP – This is a new diagnostic tool being used at several Mayo Clinic sites. During your EGD, a balloon is inflated with water and the distensibility, or stiffness, of the esophagus can be measured. This can help your doctor visualize how your esophagus reacts in the same way as if food was moving through the esophagus.
• Eosinophil Count on Pathology – From the biopsies taken during your EGD, the pathologist looks at the tissue under the microscope and counts the number of eosinophils that are seen. If a section shows more than 15 eosinophils, that is considered to have “active” disease.

These above tests and factors are all looked at together to assess the severity of the EoE that you are experiencing and how to treat it most effectively.