Pediatric Eosinophilic Esophagitis Symptom Score (PEESS) in the management of eosinophilic esophagitis in children: A narrative review of the literature
N. Aggoun Zioueche, E. Grimaud, J. Lemale, A. Lemoine
Background : Eosinophilic esophagitis (EoE) is an emerging chronic inflammatory disease of the esophagus, particularly common in atopic children. Diagnosis is based on clinical, endoscopic, and histological signs, but symptoms are often nonspecific and vary by age. To better assess the frequency and severity of symptoms and monitor paediatric patients, the PEESS v2.0 score, a standardized validated questionnaire, was developed in 2011 to be completed by parents and children if above 8 years old.
Objectives : We aim to review studies evaluating the correlation between PEESS results and clinical symptoms, endoscopic and histological severity, as well as various esophageal functional investigations in children with EoE. Methods and setting: A bibliographic search was conducted in the PubMed database using the keywords: PEESS and eosinophilic esophagitis.
Results : Sixteen articles discussing PEESS and published before August 25 were analysed. The PEESS v2.0 completed by parents is correlated with that completed by children according to 3 studies. To date, no positive predictive value has been calculated, and the score itself does not allow for diagnosis. The PEESS helps detect residual symptoms, particularly those related to seasonal allergies, and can contribute to treatment adjustments. The correlation between PEESS and histological activity is inconsistent. No study has yet evaluated the correlation between PEESS v2.0 and other esophageal functional tests (eg: manometry, impedance planimetry, endoscopic ultrasonography).
Conclusion : PEESS is a useful tool to help for diagnosis and follow-up of pediatric EoE. However, it is not specific to EoE, and no threshold is defined. Further research is needed to refine its role in the diagnosis and monitoring of EoE. In the meantime, regular endoscopic follow-up and histological analysis of esophageal biopsies remain essential despite their invasive nature.