Eosinophilic colitis: epidemiology, clinical features, and current management.

Area of Science:

• Gastroenterology
• Immunology
• Pediatrics

Background:

• Primary eosinophilic gastrointestinal disorders (EGIDs) involve eosinophil infiltration of the gut without other known causes.
• Eosinophilic colitis (EC) is the least common EGID, with distinct presentations in infants and adults.

Purpose of the Study:

• To review current knowledge on eosinophilic colitis (EC), including its epidemiology, clinical features, diagnosis, and treatment.
• To summarize the heterogeneity of EC, from acute infant cases to chronic adult presentations.

Main Methods:

• Literature review of primary eosinophilic gastrointestinal disorders, focusing on eosinophilic colitis.
• Synthesis of information on pathophysiology, clinical manifestations, diagnostic criteria, and therapeutic approaches.

Main Results:

• EC has a bimodal age distribution: acute, self-limited bloody diarrhea in infants (often food allergy-related) and chronic, relapsing colitis in young adults (T-cell mediated).
• Diagnosis is based on histopathology showing excess eosinophils; standardized criteria are lacking.
• Infant EC often resolves with dietary elimination, while adult EC may require glucocorticoids, antihistamines, leukotriene antagonists, or biologics targeting IL-5 and IgE.

Conclusions:

• Eosinophilic colitis is a complex EGID requiring tailored management based on age and underlying pathophysiology.
• Further research, including prospective trials, is needed to establish standardized diagnostic and treatment guidelines for EC.