EREFS Score for Eosinophilic Esophagitis (EoE)

including edema, rings, exudates, furrows, and strictures

The EoE Endoscopic Reference Score (EREFS) was developed as a way to quantify the major endoscopic features of EoE, including edema, rings, exudates, furrows, and strictures (the first letter of these findings also comprises the acronym for the system). 

EDEMA is graded as absent (grade 0) or present (1; decreased or absent vascularity).

RINGS are graded as absent (0), mild (1; subtle ridges), moderate (2; distinct rings), or severe (3; standard scope will not pass).

EXUDATES (or white speckles, stiplings) are graded as absent (0), mild (1; ≤10% of the mucosal surface area), or severe (2; >10% of the surface). 

FURROWS (or lines and tracks) are graded as absent (0), mild (1; present without depth), or severe (2; depth noted). 

STRICTURE is graded as absent (0) or present (1), and if possible the minimum diameter of the esophagus is recorded.

Source: E. Dellon. CGH 2021;19:2489–2492.

As there are several other endoscopic findings in EoE (visit and watch the video Eosinophilic Esophagitis: Focus on its Endoscopic Diagnosis".

We think that the classification could be expanded to include dysmotility or sitffness, the "pull-sign" ("peel-off") when performing biopsies - "DEREFS-P"


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