Remissions and relapses are common in eosinophilic esophagitis (EoE). Because there are no guidelines for identifying remission, remission is diagnosed inconsistently. The goal of this study was to identify histological remission in EoE. The validated EoE Histology Scoring System was used to assess esophageal biopsies collected at the time the validated paediatric EoE symptoms scores v2.0 questionnaire was completed. An EoE Histology Remission Score (EoEHRS) was developed, requiring that the peak eosinophil count in all esophageal locations examined be 15 per high power field (HPF); moreover, neither the overall grade nor stage scores may exceed 3. For histology/symptom associations, Spearman correlation coefficients were calculated; a coefficient range of 0.31 to 0.50 was deemed moderate. Biopsies that satisfied the complete EoEHRS criteria exhibited lower levels of biomarkers, especially the mast cell markers CPA3 and tryptase mRNA, as well as lower levels of eosinophil peroxidase deposits, as compared to nonremission scores. Subjects whose biopsies matched EoEHRS remission criteria reported decreased symptoms across the board, with the exception of nausea and vomiting.

Since the EoEHRS corresponded with lower levels of disease activity and symptoms, it may be beneficial in informing clinical management and comparing studies.