P1214 - Eosinophilic Colitis: A Rare Entity of Eosinophil-Associated Gastrointestinal Disorder

Rucha Jiyani, MD¹, Bobby Jacob, MD², Nausheer Khan, MD¹, Kaleem Rizvon, MD^1
1Nassau University Medical Center, East Meadow, NY; ²Nassau University Medical Center, Lake Grove, NY

Introduction: Gut eosinophilia develops secondary to recognized entities, such as reflux
esophagitis, H. pylori infection, medications, vasculitis, inflammatory bowel disease, malignancy and
parasitic infections. Primary eosinophilic gastrointestinal disorders (EGID) represent a spectrum of
disorders in which eosinophil infiltrate the gut mucosa in the absence of known causes. Primary EGID can be sub grouped as Eosinophilic esophagitis, Eosinophilic gastroenteritis
and Eosinophilic colitis (EC). Here we present a case of rarest subtype of EGID, EC.

Case Description/Methods: 45 year old Hispanic male presented to clinic with complaints of chronic
diarrhea and abdominal pain for 2 years. Patient denies use of medications or family history of any
inflammatory bowel disease or colon cancer. Extensive stool testing revealed secretory diarrhea, negative
for H. pylori and ova and. Colonoscopy with random biopsies were obtained from the colon and revealed
inflammation with greater than 30 eosinophils/PHF. Patients lab work revealed peripheral eosinophilia. 6
food elimination diet was recommended and patient was started on empiric prednisone 20mg daily for 2
weeks, which was tapered to 15mg for two weeks and currently he is on 10mg with reported improvement
in symptoms. Patient clinically improved on steroids and is scheduled for a repeat colonoscopy with
repeat biopsies to evaluate if resolution of eosinophilia in the colon.

Discussion: EC is exceptionally rare sub type of EGID, which has a bimodal age of onset with usually
benign course in infancy and resolves with dietary changes. An elemental or elimination diet is a
therapeutic primary strategy for EGID and is beneficial in infancy, however it has limited effect in adult
onset cases. Steroids have been used successfully in most cases in case series and reports, but has not
been supported by evidence-based study or research. Eotaxin involved in migration of eosinophil provide
base for role of immunomodulatory medications. Azathioprine and 6-Mercaptopurine are other possible
evolutionary therapies particularly to be considered as steroid sparing. There are Leukotriene D4
antagonist, antihistamine and mast cell inhibitor, but no satisfactory data is been reported. Novel biologic
such as Omalizumab and Mepolizumab through their effect on immunoglobulin E and Interleikin-5, are
novel approach for refractory cases. Considering management challenges, small case series and case
report like this might add in better understanding and management.


Disclosures:


Rucha Jiyani, MD¹, Bobby Jacob, MD², Nausheer Khan, MD¹, Kaleem Rizvon, MD¹. P1214 - Eosinophilic Colitis: A Rare Entity of Eosinophil-Associated Gastrointestinal Disorder, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.