The endoscopic reference score (EREFS) for eosinophilic esophagitis (EoE) was established to assess adults with EoE and has been effectively adapted to a juvenile population. EREFS in younger and older children with EoE are compared in this study. The 99 patients were split into three groups: 44 with active EoE (EoE-A), 16 with EoE remission (EoE-R), and 39 without. The cohorts were then split into two groups: younger and older, and the composite and individual components of their EREFS were compared. EREFS detected EoE-A 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. For ten years, the mean EREFS was 1.26 1.19, and for more than ten years, it was 2.71 1.33. Furrows, edema, and exudates were the three most prevalent observations in our whole EoE-A sample and at both ages. In both ages, EREFS in patients with EoE-A exhibited similar specificities and positive predictive values. 

The current study validates the use of EREFS in pediatric EoE. Furthermore, EREFS can identify EoE and track therapy response in both young and old children. EREFS, on the other hand, predicted EoE in older children with greater sensitivity and negative predictive value than in the younger cohort.