EOSINOPHILIC COLITIS IN CHILDREN WITH NEURODISABILITY: A TERTIARY CENTER'S EXPERIENCE OF FOUR CASES.

Jain, S.; Turner, K.; Rummery, R.; Stahlschmidt, J.; Zamvar, V.

EOSINOPHILIC COLITIS IN CHILDREN WITH NEURODISABILITY: A TERTIARY CENTER'S EXPERIENCE OF FOUR CASES.

All Authors

Jain, S.

Turner, K.

Rummery, R.

Stahlschmidt, J.

Zamvar, V.

LTHT Author

Jain, Shalu
Turner, Kerry
Rummery, Rachel
Stahlschmidt, Jens
Zamvar, Veena

LTHT Department

Leeds Children's Hospital
Children's Services
Pathology
Histopathology
Paediatric Pathology
Paediatric Gastroenterology

Publication Date

2025

Item Type

Conference Abstract

Abstract

Eosinophilic colitis (EoC) is a subtype of eosinophilic gastrointestinal disorders (EGID) beyond eosinophilic esophagitis (EoE) which has been recently updated as a nomenclature.1 It describes chronic inflammatory disorders of the gastrointestinal (GI) tract characterized clinically by the GI symptoms and histologically by eosinophilic inflammation, in the absence of a secondary cause. EoC is the least understood of the non-EoE. EGIDs, as its clinical presentation can be confused with IBD (inflammatory bowel disease) such as ulcerative colitis or Crohn disease.2 We report 4 patients who were referred to us with chronic per rectal bleeding, abdominal pain and diarrhea and raised faecal calprotectin. The median age was 11 years. They all had neuro-disability with severe development delay, non-verbal and were gastrostomy fed. Two of them had underlying syndromes. All of them were on hypoallergenic feeds with no allergic history. There were no drug associations found. On upper endoscopy and colonoscopy, there were patchy areas of submucosal hemorrhages which were mainly identified in the proximal colon. Macroscopically (figure 1), they have not been described in EoC but correlated histologically with the suggested threshold peak eosinophil counts of EoC. One had associated EoE but the remaining did not have any upper GI changes. One of them was eventually diagnosed with Crohn's disease and subsequently passed away due to other, non GI related health issues. Rest were treated with sulfasalazine and are currently symptom free. We concluded that faecal calprotectin can be elevated in children with EoC.3 The macroscopic findings at colonoscopy were unique to these children with neuro-disability. They were all on anti-epileptic medications but none of them are reported to be associated with EoC as an adverse effect. The presence of thresh-hold increased eosinophils in the colonic mucosa requires consideration for a secondary cause, especially IBD as EoC is rare and remains a diagnosis of exclusion. More data to ascertain if EGID is more common in neuro-disabled children is required since there is a lack of published data about EGID.