# Eosinophilic oesophagitis endoscopic reference score EREFS Status: LIVE Price: $0.005 USDC `GET /api/calc/erefs` HTML: https://magentlab.com/docs/erefs Markdown: https://magentlab.com/docs/erefs.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes 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. ## 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 [Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system.](https://doi.org/10.1136/gutjnl-2011-301817) Hirano I, Moy N, Heckman MG, Thomas CS, Gonsalves N, Achem SR Gut. 2013;62(4):489-495 DOI: [10.1136/gutjnl-2011-301817](https://doi.org/10.1136/gutjnl-2011-301817) ## Worked example ### All descriptors absent or none Given: `edema=absent, exudates=none, furrows=absent, rings=none, stricture=absent` 1. edema absent 0 + rings none 0 + exudates none 0 + furrows absent 0 + stricture absent 0 2. Score = 0 (max 8). No activity band. ### All descriptors maximum Given: `edema=present, exudates=severe_gt_10pct, furrows=present, rings=severe, stricture=present` 1. edema present 1 + rings severe 3 + exudates severe_gt_10pct 2 + furrows present 1 + stricture present 1 2. 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 ## Parameters - `edema` (string, required): 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): 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): 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): 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): 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. Method: `POST /api/calc/erefs` Max items: 25 Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic) Status: 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: ```json { "items": [ { "edema": "absent", "exudates": "none", "furrows": "absent", "rings": "none", "stricture": "absent" }, { "edema": "absent", "exudates": "none", "furrows": "absent", "rings": "none", "stricture": "absent" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/erefs Example 200: ```json { "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 fields - `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 Frozen fixture. Not a live lookup. ```json { "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" } ``` ## Errors - HTTP 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. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - [UCEIS](https://magentlab.com/docs/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](https://magentlab.com/docs/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. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional. - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/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.