Eosinophilic colitis in children: a new and elusive enemy?

Area of Science:

• Pediatric Gastroenterology
• Gastrointestinal Pathology
• Allergy and Immunology

Background:

• Eosinophilic gastrointestinal disorders (EGID) are rare in children, presenting with diverse, non-specific symptoms.
• Lack of validated guidelines for diagnosis, therapy, and follow-up complicates management of eosinophilic colitis (EC).
• Understanding associated conditions and clinical presentation is crucial for EC diagnosis and treatment.

Purpose of the Study:

• To investigate eosinophilic colitis (EC) in pediatric patients.
• To explore potential correlations between EC and associated disorders, macroscopic endoscopic findings, and treatment outcomes.
• To contribute to the understanding of this challenging pediatric gastrointestinal pathology.

Main Methods:

• Retrospective analysis of colonoscopies performed between 2015 and 2019.
• Eosinophilic colitis (EC) diagnosis based on established eosinophil counts per high-power field (HPF) in different colonic segments.
• Exclusion of patients with inflammatory bowel disease (IBD) or other causes of hypereosinophilia.

Main Results:

• Fifty cases of EC were diagnosed in 355 patients undergoing 399 colonoscopies; median age was 8.5 years.
• Common symptoms included recurrent abdominal pain (66%) and chronic diarrhea (64%).
• A significantly higher prevalence of autistic spectrum disorder (ASD) was observed in EC patients (44% vs. 28.5%, p=0.03).
• Histological persistence of eosinophils was noted in 75% of patients with available follow-up, irrespective of symptom relief.

Conclusions:

• Eosinophilic colitis (EC) presents a diagnostic and therapeutic challenge in pediatric patients.
• The high comorbidity with autistic spectrum disorder (ASD) requires further investigation.
• Multicentric randomized trials are essential to establish diagnostic criteria, endoscopic scores, histological thresholds, and standardized therapies for EC.