Eosinophilic colitis K52.9

Rare, immune-mediated, eosinophilic, inflammatory bowel disease of unclear etiology, belonging to the group of eosinophilic gastrointestinal diseases(eosinophilic esophagitis, eosinophilic gastroenteritis, etc.).

The cause is an intestinal wall infiltration with eosinophilic granulocytes, which induces an unspecific inflammatory reaction of different localization, extension and morphology. The clinical symptoms correlate with the extent of eosinophilic infiltration, but not with the level of IgE. In particular, allergic diathesis can be detected in children (e.g. food allergy). Cephalosporins have also been described as triggers.

Possible at any age. In childhood and adolescence (average 12.1 years); in later adulthood between 30 and 50 years of age

The cardinal symptom of the disease is right-sided lower abdominal pain (often cecum and ascending colon are affected) combined with bloody (29%) or non-bloody diarrhea (57%) and weight loss (29%). Endoscopically, pseudopolyposis lumen constrictions with ileus symptoms, small ulcers, bleeding or perforations are detected.

Possibly eosinophilia of the blood, IgE increased in 50% of cases. No indication between IgE level and clinical symptoms. Occasionally ANCA was detected.

Mucosal or transmural eosinophilic infiltration of the wall of the colon

Conservative therapy approaches with discontinuation of questionable noxious agents and systemic corticosteroid applications are primarily indicated.

Only if the symptoms persist will a resection intervention be unavoidable.

In most cases the diagnosis is not (preferably) secured endoscopically and bioptically, but is forced by exploratory laparotomy under the suspected diagnosis of acute appendicitis.

Other eosinophilic organ manifestations are possible: infestation of the oesophagus(eosinophilic oesophagitis), stomach(eosinophilic gastroenteritis), lungs (eosinophilic pneumonia), infestation of the bladder (eosinophilic cystitis).

Alfadda AA et al (2014) Eosinophilic colitis is a sporadic self-limited disease of middle-aged people: a population-based study. Colorectal Dis 16:123-129.

Alfadda AA et al (2011) Eosinophilic colitis: an update on pathophysiology and treatment. Br Med Bull 100:59-72.

Grzybowska-Chlebowczyk U et al (2017) Eosinophilic colitis in children. Postepy Dermatol Alergol 34:52-59.

Mogilevski T et al. (2015) β-lactam-associated eosinophilic colitis. BMJ Case Rep doi: 10.1136/bcr-2014-206964.

Uppal V et al (2016) Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. Clin Rev Allergy Immunol 50:175-188.

Yozgat A et al (2015) Eosinophilic colitis under etanercept. Acta Gastroenterol Belg 78:439-440.