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Eosinophilic Colitis—Child

Definition

Eosinophilic colitis (EC) is the buildup of white blood cells called eosinophils. They gather in the lining of the colon. EC causes long term inflammation.
There are two types of EC:
  • Primary—EC that occurs on its own
  • Secondary—EC that is present because of another disease
EC in infants will go away on its own with time. Adolescent EC may cycle between symptom free and severe symptoms.

Causes

Eosinophils are part of the immune system. They should only respond to an infection or injury. These cells release a chemical that causes inflammation. With EC, the inflammation starts or continues even though it is not needed. Over time this can lead to tissue damage, ulcers, and polyps in the colon.
It is not clear what causes EC. It is likely a blend of gene defects and the environment. It may also be linked to an allergic reaction.

Risk Factors

EC is more common in males. Other factors that may increase a child’s chances of EC include:
  • Certain genetic problems
  • Family members with EC or allergies
  • Food allergies
  • Having other conditions, such as other eosinophilic gastrointestinal diseases

Symptoms

Symptoms vary and may be more severe in some people.
Common symptoms include:
  • Severe belly pain
  • Diarrhea, with or without blood
  • Nausea
  • Vomiting
  • Fatigue
  • Problems feeding in infants
Complications may include:
  • Malnutrition
  • Weight loss
  • Anemia or iron deficiency from blood loss

Diagnosis

You will be asked about your child’s symptoms and past health. A physical exam will be done. EC is hard to diagnose with simple tests. Some tests may be able to rule out other conditions with similar symptoms.
Tests to rule other other conditions may include:
  • Blood tests
  • Allergy tests
  • Stool tests
  • Barium enema—a type of x-ray that uses contrast material to highlight the colon
  • Colonoscopy—a lighted tube with a camera is used to view the lining of the colon
A biopsy is the only way to confirm EC. A sample of the colon will be removed. It will be sent to a lab to look for eosinophils. This will be done through a colonoscopy.
Colonoscopy
Colonoscope
Copyright © Nucleus Medical Media, Inc.

Treatment

EC in infants will go away on its own. Removing cow’s milk and soy from the diet may help until EC is gone.
For others, the goal of treatment is to manage inflammation. This will stop or slow damage to the lining of the colon. If an underlying cause is identified, it will need to be treated.
Treatment options may include:

Dietary Changes

Foods that cause symptoms will need to be avoided. Proteins, such as soy, nuts, eggs, or milk are common allergens. A dietitian can help to guide dietary needs.
Other changes may include:
  • Some may have severe protein limits. Special liquid formulas may be needed to provide safer forms of protein. In some cases, a feeding tube may be used.
  • A nutrition plan may be needed to support growth. This may include vitamins and supplements.

Medicine

Medicines are used to manage EC and treat complications. These may include:
  • Steroids—to reduce inflammation during symptom flare ups. May be given as pills or passed into the colon.
  • Medicine to boost, change, or suppress the immune system.

Prevention

There are no steps to prevent EC because the cause is unknown.

RESOURCES

American Partnership for Eosinophilic Disorders
http://apfed.org
Healthy Children—American Academy of Pediatrics
https://www.healthychildren.org

CANADIAN RESOURCES

Canadian Association of Gastroenterology
https://www.cag-acg.org
Sick Kids—The Hospital for Sick Children
http://www.sickkids.ca

References

Alfadda AA, Storr MA, Shaffer EA. Eosinophilic colitis: epidemiology, clinical features, and current management. Therap Adv Gastroenterol. 2011;4(5):301-309.
Eosinophilic colitis. American Partnership for Eosinophilic Disorders website. Available at: http://apfed.org/about-ead/egids/ec. Updated November 11, 2014. Accessed January 11, 2019.
Lozinsky AC, Morais MB. Eosinophilic colitis in infants. J Pediatr (Rio J). 2014;90(1):16-21.
Uppal V, Kreiger P, Kutsch E. Eosinophilic gastroenteritis and colitis: a comprehensive review. Clin Rev Allergy Immunol. 2016;50(2):175-188.

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