Treatment of Eosinophilic Colitis

Pharmacological Treatment Options

The duration of treatment with corticosteroids should be at least 8-12 weeks before evaluating the histological response 1
Proton pump inhibitors (PPIs) may be considered as complementary therapy in eosinophilic colitis, with a recommended dose of omeprazol 20 mg twice a day for 8-12 weeks 1

A dietitian's support is recommended during the process of elimination and reintroduction of foods 2
Dietary elimination may be effective in cases where a food allergy is identified as a trigger, and a dietitian's expertise is crucial in this process 2

Novel biologics used in other allergic conditions, such as dupilumab, cendakimab, and benralizumab, have shown promising results in eosinophilic disorders, although evidence specific to eosinophilic colitis is limited 2
Anti-TNF and anti-integrin monoclonal antibody therapies, typically used for inflammatory bowel disease, are not recommended as routine treatment for eosinophilic colitis 3

Endoscopy with biopsy is recommended while the patient is on treatment to evaluate the histological response, as symptoms do not always correlate with histological activity 2
If symptoms recur during treatment, endoscopy should be repeated for evaluation and to obtain more histology 3
In cases of refractory treatment, joint management by a gastroenterologist and an allergist specialist is recommended to optimize treatment 3

Secondary causes that must be ruled out include food allergies, which is a crucial step in the diagnostic process, as emphasized by the European Society of Gastroenterology 4

Dietary elimination therapy should only be conducted under the supervision of an experienced dietitian, and a recommended approach is a two-food elimination diet (TFED) stepping up to more restrictive diets if needed, as suggested by the British Dietetic Association 4
The initial step in dietary elimination therapy is to eliminate milk +/- wheat or egg for 8-12 weeks, with subsequent adjustments based on response, under the guidance of a registered dietitian, as recommended by the Academy of Nutrition and Dietetics 4
Endoscopic and histological assessment should be performed between 8-12 weeks after each dietary change to evaluate the effectiveness of the treatment, as advised by the American Gastroenterological Association 4

The psychological impact of dietary therapy on patients with eosinophilic colitis should be discussed, including the potential for anxiety and depression related to persistent symptoms and social restrictions, as highlighted by the National Institute of Mental Health 5