Is Eosinophilic Colitis a Forerunner of Inflammatory Bowel Disease?

Eosinophilic colitis (EoC) has an increasing association with inflammatory bowel disease (IBD), and there is a paucity of data on the natural history of EoC. Here, we provide a comprehensive overview of EoC and critically evaluate the evidence supporting its potential association with, or evolution into IBD.

Experts currently classify EoC as one of the eosinophilic gastrointestinal disorders (EGID) beyond eosinophilic esophagitis (EoE). Transcriptomic analyses have demonstrated a distinct molecular signature for EoC. However, recent studies suggest that a subset of patients with EoC may progress to develop IBD. The key predictive factors include high eosinophilic density on colonic biopsy and poor response or relapse following standard therapy. Emerging evidence suggests that EoC may precede or overlap with IBD. The lack of standardized diagnostic criteria and limited longitudinal data hinder firm conclusions and warrant future prospective multicenter studies. Available current literature suggests that clinicians should be vigilant with persistent or severe symptomatic patients despite standard treatment to evaluate for IBD.