Eosinophilic colitis: epidemiology, clinical features, and current management

Abstract

Primary eosinophilic gastrointestinal disorders (EGIDs) represent a spectrum of inflammatory gastrointestinal disorders in which eosinophils infiltrate the gut in the absence of known causes for such tissue eosinophilia. EGIDs can be subgrouped as eosinophilic esophagitis (EE), eosinophilic gastroenteritis (EG), and eosinophilic colitis (EC). The least frequent manifestation of EGIDs is EC. EC is a heterogeneous entity with a bimodal age distribution, presenting with either an acute self-limited bloody diarrhea in otherwise healthy infants or as a more chronic relapsing colitis in young adults. The pathophysiology of primary EC appears related to altered hypersensitivity, principally as a food allergy in infants and T lymphocytemediated (i.e. non-IgE associated) in young adults. In adults, symptoms include diarrhea, abdominal pain, and weight loss. Endoscopic changes are generally modest, featuring edema and patchy granularity. Although standardized criteria are not yet established, the diagnosis of EC depends on histopathology that identifies an excess of eosinophils. Therapeutic approaches are based on case reports and small case series, as prospective randomized controlled trials are lacking. Eosinophilic colitis in infants is a rather benign, frequently food-related entity and dietary elimination of the aggressor often resolves the disorder within days. Adolescent or older patients require more aggressive medical management including: glucocorticoids, antihistamines, leukotriene receptors antagonists as well as novel approaches employing biologics that target interleukin-5 (IL-5) and IgE. This review article summarizes the current knowledge of EC, its epidemiology, clinical manifestations, diagnosis, and treatment.

Eosinophilic Gastroenteritis Presenting with Severe Anemia and Near Syncope

“…Eosinophilic gastroenteritis is a condition in which eosinophils infiltrate either the stomach or small bowel, and approximately 50% may have atopic disorders, food intolerances, or food allergies. 4 Eosinophilic colitis is a rare condition that causes colonic eosinophilia, and patients typically present with abdominal pain, diarrhea, and weight loss. 4 The clinical manifestations of EGIDs depend on which layer and which bowel segments are predominantly involved.…”

Eosinophilic Colitis Presenting with Chronic Diarrhea

“…Our case is the patient with young adult, matched the age prevalence of this disease. 1,2,5 In EC, endoscopy may show edematous mucosa with a loss of the normal vascular pattern, patchy erythematous changes, and even superficial ulcerations. Eosinophilic infiltrations in the mucosal biopsy anywhere in the gastrointestinal tract is diagnostic if the other reasons (parasites, drug use, malignancy) are excluded.…”

“…3 Eosinophil count in the colon is increased in various disorders such as food allergy, parasitic infections, and inflammatory bowel disease. 1,8 Eosinophils location in the intestines allows ready access for these white blood cells to combat multicellular parasites, likely an evolutionary survival tool.…”

“…Corticosteroids works by inhibit eosinophil growth factors: interleukin-3 (IL-3), interleukin-5 (IL-5), and granulocyte-macrophage colony-stimulating factor (GM-CSF). 1,3 Antihistamines, mast cell stabilizer, and leukotriene antagonists are other drugs than can be used in the treatment of EC. In this case, corticosteroids were used to inhibit inflammatory responses caused by eosinophils.…”

“…1 Besides EC, EGIDs also consisted of eosinophilic esophagitis (EE) and eosinophilic gastroenteritis (EG). 2 EC is the rarest EGIDs entity with most of the cases being reported in the last three decades.…”