Eosinophilic Esophagitis Endoscopic Reference Score (EREFS)
Evaluates severity of endoscopic findings in patients with eosinophilic esophagitis (EoE).
- During every endoscopy, assign the overall EREFS using the segment that shows the worst (highest) score, ensuring the maximal disease burden is captured.
- If greater detail is desired, record separate scores for the proximal and distal esophagus instead of, or in addition to, the composite score.
Advice
- Always interpret the results of this tool together with symptom severity and biopsy results to capture the full spectrum of EoE activity and therapeutic response.
- Successful treatment should drive down the inflammatory subscores (edema, exudates, furrows); therapy options include:
- Proton pump inhibitors (PPIs).
- Topical corticosteroids (e.g., budesonide, fluticasone).
- Biologic therapy (e.g., dupilumab).
- Dietary modifications.
- Fibrostenotic features (rings, strictures) seldom regress with medication alone; plan endoscopic dilation when dysphagia or food-impaction risk persists despite adequate anti-inflammatory therapy.
- Repeat upper endoscopy with EREFS calculation about 6–12 weeks after starting or escalating treatment, after any de-escalation, and at clinically driven intervals (typically every 12–24 months) to verify and maintain remission.