Eosinophilic colitis in adults - 11/10/20
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Highlights |
• | Eosinophilic gastrointestinal disorders are characterised by abnormal eosinophilic infiltration of different segments of the gastrointestinal tract in the absence of an identifiable secondary cause. Eosinophilic esophagitis is the most common of these conditions, eosinophilic colitis (EC) being less common, although the prevalence of these other eosinophilic gastrointestinal disorders has not been well described. The high proportion of coexisting atopic diseases suggests that the incidence of EC could, as with eosinophilic esophagitis, increase in the near future. |
• | EC occur in both children and adults, and because they are uncommon in adults, epidemiologic features, risk factors and pathophysiological mechanisms are not certain. |
• | The incidence of chronic diarrhea with normal or quasi-normal colonoscopy increasing, it is important to know the main causes of these. Before accepting the diagnosis of irritable bowel syndrome with diarrhea, it is necessary to rule out, among others, possible microscopic colitis or EC by performing staged colonic biopsies. |
• | This review details: (a) classification of EC, primary or secondary origin with etiological assessment to be carried out in practice; (b) the histological diagnostic criteria that can be retained despite the lack of consensus; (c) the clinical, biological, endoscopic and progressive characteristics of the CE; (d) therapeutic management of primary CE. |
Summary |
Eosinophilic colitis (EoC) is a pathological entity associated with abnormal infiltration of colonic mucosa by eosinophilic polynuclear cells (Eo). This is a relatively common pathology in infants and children under 2 years old, but is more rare and has been less studied in adults. EoC can be classified as primary or secondary. Primary EoC is, in the majority of cases, related to an allergic reaction, either IgE-mediated and capable of causing an anaphylactic-type food allergy, or not mediated by IgE and capable of giving rise to food enteropathy. The symptoms for adults with EoC are variable and non-specific, diarrhoea and abdominal pain being the most common signs. There is no histological consensus for the diagnosis of EoC. The presence of over 40 Eo per high-power field (×400) in at least two different colonic segments could be suggested as the criterion for the diagnosis. In adults with primary EoC, skin tests are of limited value and the response to a restrictive diet is less effective than in young children, given that IgE or non-IgE-mediated allergic reactions are rarely identified and EoC generally require medical treatment. There is no consensus on the treatment of EoC, but the potential efficacy of corticosteroids and budesonide has been demonstrated in the vast majority of cases studied.
Le texte complet de cet article est disponible en PDF.Keywords : Primary and secondary eosinophilic colitis, Allergy, Corticosteroids
Abbreviations : Eo, EoC, IL-3 and IL-5, HPF, IBD, HES
Plan
Vol 44 - N° 5
P. 630-637 - octobre 2020 Retour au numéro
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