GI · LIVE

Eosinophilic oesophagitis endoscopic reference score

EREFS

Sum five caller-assigned Hirano 2013 modified EREFS descriptors (edema 0-1, rings 0-3, exudates 0-2, furrows 0-1 after collapsing original 0-2, stricture 0-1) and return the total (max 8). Does not return activity bands, inflammatory or fibrostenotic subscores, or later 0-9 furrows 0-2 expansions.

LIVE $0.005 USDC GET /api/calc/erefs

Markdown: /docs/erefs.md · Canonical: https://magentlab.com/docs/erefs

Not a medical device. Not a diagnosis, dose, or listing recommendation.

What it computes

When to use

When an agent has already assigned Hirano 2013 modified edema, rings, exudates, furrows, and stricture at endoscopy and needs the five-item 0-8 total, not a diagnosis, inflammatory/fibrostenotic subscores, or the later 0-9 expansion that restores furrows 0-2.

When not to use

Not a medical device and not a diagnosis of eosinophilic oesophagitis or a treatment order.
Each descriptor is a caller-assigned Hirano 2013 modified token. magent does not perform endoscopy.
Furrows use the modified good-agreement collapse (absent 0, present 1). This is not original Hirano 2013 furrows 0-2 and not later 0-9 expansions that restore furrows 0-2.
Hirano 2013 did not publish mild, moderate, or severe cutoffs for the total score. magent returns score and max_score only and does not apply later EREFS activity bands.
Crepe-paper mucosa and narrow-calibre oesophagus are not included in the sum. Inflammatory and fibrostenotic subscores are not returned.

Formula

EREFS = edema (absent 0, present 1; loss of vascular markings) + rings (none 0, mild 1, moderate 2, severe 3) + exudates (none 0, mild_lt_10pct 1, severe_gt_10pct 2) + furrows (absent 0, present 1; modified, original 0-2 collapsed) + stricture (absent 0, present 1); Hirano 2013 modified good-agreement version; not later 0-9 furrows 0-2; crepe-paper and narrow-calibre not scored; no published total-score activity bands

Citation

Title: Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system.
Authors: Hirano I, Moy N, Heckman MG, Thomas CS, Gonsalves N, Achem SR
Source: Gut. 2013;62(4):489-495
DOI: 10.1136/gutjnl-2011-301817

Worked example

All descriptors absent or none

Given: edema=absentexudates=nonefurrows=absentrings=nonestricture=absent

edema absent 0 + rings none 0 + exudates none 0 + furrows absent 0 + stricture absent 0
Score = 0 (max 8). No activity band.

All descriptors maximum

Given: edema=presentexudates=severe_gt_10pctfurrows=presentrings=severestricture=present

edema present 1 + rings severe 3 + exudates severe_gt_10pct 2 + furrows present 1 + stricture present 1
Score = 8 (max 8). No activity band.

Also searched as

EREFS
eosinophilic oesophagitis endoscopic reference score
EoE EREFS
Hirano EREFS
EREFS score
eosinophilic esophagitis endoscopy score
modified EREFS
EoE endoscopic reference score
Hirano 2013 EREFS
oesophageal EREFS

Try

Opens the live endpoint. Unpaid browser requests show the paywall; agents should send Accept: application/json.

/api/calc/erefs?edema=absent&rings=none&exudates=none&furrows=absent&stricture=absent

Full URL: https://api.magentlab.com/api/calc/erefs?edema=absent&rings=none&exudates=none&furrows=absent&stricture=absent

Call

Expect HTTP 402 until you retry with PAYMENT-SIGNATURE. Incomplete query params return HTTP 400 before any quote or charge.

curl -i -H "Accept: application/json" "https://api.magentlab.com/api/calc/erefs?edema=absent&rings=none&exudates=none&furrows=absent&stricture=absent"

Parameters

Name	Type	Required	Description
`edema`	string	required · absent, present	Caller-assigned Hirano 2013 modified EREFS edema (oedema; loss of vascular markings): absent (0; vascular markings present) or present (1; decreased or absent vascular markings). magent does not perform endoscopy.
`rings`	string	required · none, mild, moderate, severe	Caller-assigned Hirano 2013 EREFS rings (fixed rings): none (0), mild (1; subtle circumferential ridges), moderate (2; distinct rings that a diagnostic adult endoscope still passes), or severe (3; cannot pass a diagnostic adult endoscope). magent does not perform endoscopy.
`exudates`	string	required · none, mild_lt_10pct, severe_gt_10pct	Caller-assigned Hirano 2013 EREFS exudates (white plaques): none (0), mild_lt_10pct (1; lesions involving <10% of the oesophageal surface area), or severe_gt_10pct (2; lesions involving >10% of the oesophageal surface area). magent does not perform endoscopy.
`furrows`	string	required · absent, present	Caller-assigned Hirano 2013 modified EREFS furrows (vertical lines): absent (0) or present (1). Original Hirano 2013 graded furrows 0-2 (none / mild without depth / severe with indentation); the modified good-agreement version collapses that to absent vs present. Not the later 0-9 expansion that restores furrows 0-2. magent does not perform endoscopy.
`stricture`	string	required · absent, present	Caller-assigned Hirano 2013 EREFS stricture: absent (0) or present (1). magent does not perform endoscopy.

Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

POST /api/calc/erefs Max 25 unit_amount + extra_item_amount * (n - 1) extra $0.002 PREVIEW

1 to 25 items. Each item uses the same keys as the GET query parameters.
POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request (fixture)

{
  "items": [
    {
      "edema": "absent",
      "exudates": "none",
      "furrows": "absent",
      "rings": "none",
      "stricture": "absent"
    },
    {
      "edema": "absent",
      "exudates": "none",
      "furrows": "absent",
      "rings": "none",
      "stricture": "absent"
    }
  ]
}

Open bulk paywall →

Opens a two-item fixture on the API host. Unpaid browsers get the same MetaMask paywall as GET; Pay retries POST with those items.

Example 200 (fixture)

{
  "count": 2,
  "path": "/api/calc/erefs",
  "items": [
    {
      "components": [
        {
          "value": "absent",
          "factor": "edema",
          "points": 0,
          "present": true
        },
        {
          "value": "none",
          "factor": "rings",
          "points": 0,
          "present": true
        },
        {
          "value": "none",
          "factor": "exudates",
          "points": 0,
          "present": true
        },
        {
          "value": "absent",
          "factor": "furrows",
          "points": 0,
          "present": true
        },
        {
          "value": "absent",
          "factor": "stricture",
          "points": 0,
          "present": true
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Hirano I, Moy N, Heckman MG, Thomas CS, Gonsalves N, Achem SR",
        "doi": "10.1136/gutjnl-2011-301817",
        "id": "hirano-2013",
        "pmid": "22619364",
        "source": "Gut. 2013;62(4):489-495",
        "title": "Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system."
      },
      "formula": "erefs",
      "formula_expression": "EREFS = edema (absent 0, present 1; loss of vascular markings) + rings (none 0, mild 1, moderate 2, severe 3) + exudates (none 0, mild_lt_10pct 1, severe_gt_10pct 2) + furrows (absent 0, present 1; modified, original 0-2 collapsed) + stricture (absent 0, present 1); Hirano 2013 modified good-agreement version; not later 0-9 furrows 0-2; crepe-paper and narrow-calibre not scored; no published total-score activity bands",
      "max_score": 8,
      "score": 0,
      "edema": "absent",
      "exudates": "none",
      "furrows": "absent",
      "rings": "none",
      "stricture": "absent"
    },
    {
      "components": [
        {
          "value": "absent",
          "factor": "edema",
          "points": 0,
          "present": true
        },
        {
          "value": "none",
          "factor": "rings",
          "points": 0,
          "present": true
        },
        {
          "value": "none",
          "factor": "exudates",
          "points": 0,
          "present": true
        },
        {
          "value": "absent",
          "factor": "furrows",
          "points": 0,
          "present": true
        },
        {
          "value": "absent",
          "factor": "stricture",
          "points": 0,
          "present": true
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Hirano I, Moy N, Heckman MG, Thomas CS, Gonsalves N, Achem SR",
        "doi": "10.1136/gutjnl-2011-301817",
        "id": "hirano-2013",
        "pmid": "22619364",
        "source": "Gut. 2013;62(4):489-495",
        "title": "Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system."
      },
      "formula": "erefs",
      "formula_expression": "EREFS = edema (absent 0, present 1; loss of vascular markings) + rings (none 0, mild 1, moderate 2, severe 3) + exudates (none 0, mild_lt_10pct 1, severe_gt_10pct 2) + furrows (absent 0, present 1; modified, original 0-2 collapsed) + stricture (absent 0, present 1); Hirano 2013 modified good-agreement version; not later 0-9 furrows 0-2; crepe-paper and narrow-calibre not scored; no published total-score activity bands",
      "max_score": 8,
      "score": 0,
      "edema": "absent",
      "exudates": "none",
      "furrows": "absent",
      "rings": "none",
      "stricture": "absent"
    }
  ]
}

Response

Field	Type	Description
`formula`	string	erefs
`formula_expression`	string	Exact expression used
`score`	integer	Hirano 2013 modified EREFS points 0-8 (furrows collapsed to absent/present; not later 0-9)
`max_score`	integer	Always 8
`edema`	string	Caller-assigned token: absent or present
`rings`	string	Caller-assigned token: none, mild, moderate, or severe
`exudates`	string	Caller-assigned token: none, mild_lt_10pct, or severe_gt_10pct
`furrows`	string	Caller-assigned token: absent or present (modified; not original 0-2)
`stricture`	string	Caller-assigned token: absent or present
`components`	array	Per-descriptor caller-assigned points
`citation`	object	Hirano et al. Gut 2013 citation
`disclaimer`	string	Not-a-device notice

Example JSON

Machine form of the same example. Frozen fixture. Not a live lookup.

{
  "components": [
    {
      "value": "absent",
      "factor": "edema",
      "points": 0,
      "present": true
    },
    {
      "value": "none",
      "factor": "rings",
      "points": 0,
      "present": true
    },
    {
      "value": "none",
      "factor": "exudates",
      "points": 0,
      "present": true
    },
    {
      "value": "absent",
      "factor": "furrows",
      "points": 0,
      "present": true
    },
    {
      "value": "absent",
      "factor": "stricture",
      "points": 0,
      "present": true
    }
  ],
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Hirano I, Moy N, Heckman MG, Thomas CS, Gonsalves N, Achem SR",
    "doi": "10.1136/gutjnl-2011-301817",
    "id": "hirano-2013",
    "pmid": "22619364",
    "source": "Gut. 2013;62(4):489-495",
    "title": "Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system."
  },
  "formula": "erefs",
  "formula_expression": "EREFS = edema (absent 0, present 1; loss of vascular markings) + rings (none 0, mild 1, moderate 2, severe 3) + exudates (none 0, mild_lt_10pct 1, severe_gt_10pct 2) + furrows (absent 0, present 1; modified, original 0-2 collapsed) + stricture (absent 0, present 1); Hirano 2013 modified good-agreement version; not later 0-9 furrows 0-2; crepe-paper and narrow-calibre not scored; no published total-score activity bands",
  "max_score": 8,
  "score": 0,
  "edema": "absent",
  "exudates": "none",
  "furrows": "absent",
  "rings": "none",
  "stricture": "absent"
}

Client errors (HTTP 400)

Invalid params return 400 without charge. Shared HTTP 402 and 503 meanings: Payments.

HTTP	Code	When
400	`invalid_erefs`	edema must be absent or present; rings must be none, mild, moderate, or severe; exudates must be none, mild_lt_10pct, or severe_gt_10pct; furrows must be absent or present; stricture must be absent or present (Hirano 2013 modified EREFS). Returned before settlement; you are not charged.
400	`invalid_items`	POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
400	`invalid_item_count`	items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
400	`invalid_item`	each items entry must be a JSON object Returned before settlement; you are not charged.

Related tools

UCEIS — Sum three caller-assigned Travis 2013 UCEIS descriptors (vascular_pattern 0-2, bleeding 0-3, erosions_ulcers 0-3) scored at the most severely affected flexible-sigmoidoscopy segment and return the total (max 8). Uses the 2013 0-8 recode (normal 0). Does not return activity bands.
LA grading — Apply Lundell 1999 Table 1 Los Angeles classification of oesophagitis and return la_grade (none, A, B, C, or D) from four caller-assigned endoscopic flags.

Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. Unpaid valid requests return HTTP 402 with a base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote: retry the same PAYMENT-SIGNATURE. Full handshake and shared payment errors: Payments. Stdio MCP: /docs/mcp.

Guarantees

HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
Execution is timeout-bounded and concurrency-capped.
Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.