Eosinophilic Colitis vs Ulcerative Colitis: Differences

Ulcerative colitis (UC) and eosinophilic colitis (EC) are both conditions that cause inflammation of the colon, with symptoms of diarrhea, abdominal pain, and cramping. There are key differences in terms of prevalence and causes.

This article describes some of the key differences between the two conditions.

UC is a form of inflammatory bowel disease (IBD) that causes inflammation of the large intestine.

EC is a rare type of eosinophilic gastrointestinal disease. It develops when a high number of eosinophils, a type of white blood cell that fights bacteria, appears in a person’s large intestine, causing inflammation.


UC is relatively common, with a prevalence of 156 and 291 cases per 100,000 people. Conversely, EC develops in 2.1 cases per 100,000 people.

Remission vs relapse

CU and CE can occur in flare-ups and with periods of remission, where symptoms vary from acute, mild, severe, or completely gone.

While both UC and CE tend to be chronic, some people with CE experience only one flare of symptoms, while others may experience several.

Learn more about UC remission.


A paper 2021 notes that the onset of UC tends to occur when the person is between 15 and 30 years old, with a second, smaller peak occurring when the person is between 50 and 70 years old.

EC can affect both adults and children and often manifests before the age of 6 months. EC in children usually resolves on its own.

Although the exact causes are unknown, certain factors contribute to UC, such as:

Research from 2021 suggests that a person’s immune system responding to a viral or bacterial infection can trigger UC. The typical immune system causes temporary inflammation in a person’s body to help fight infections. In a person with UC, the inflammation persists after the immune system clears the infection, causing ulcers in the gut.

Another one 2016 review also suggests that genetic factors may contribute to UC. If someone has a first-degree relative with UC, their risk of also developing the disease is between 1.6% and 30%. However, people without a family history of UC can still develop the disease.

Health experts do not know the exact mechanism behind EC. However, a 2020 study found that in their sample of people with CE:

  • 62% had an intolerance to a type of food
  • 80% had a history of atopic disease, which can include conditions such as:
  • 16% had a family history of a condition similar to EC

CE and CU have similar symptoms that involve:

In addition to bowel symptoms, EC and UC symptoms can include:

When diagnosing UC, a doctor will ask about a person’s symptoms and whether they have a family history of similar conditions. Laboratory tests on blood samples and stool samples can rule out the possibility that a bacteria, virus, or parasite is causing the symptoms.

If a doctor suspects UC, they may recommend performing a colonoscopy, which they perform on an outpatient basis.

The doctor inserts a thin, flexible camera into the anus to examine the colon and look for signs of UC, such as inflammation and ulcers. They may also take a biopsy during the procedure.

Learn more about diagnosing UC.

Diagnosing CE involves diagnostic tests similar to those for UC, including blood tests to look for an eosinophil count and a colonoscopy to rule out other causes for the symptoms.

However, the diagnosis of CE is not always straightforward, and doctors tend to base it on the exclusion of potential causes of irritation or a high number of eosinophils in the colon. These causes include IBD, infections, and an adverse reaction to medications.

Treatment aims to reduce inflammation, manage symptoms, and regulate the immune system response. To treat UC, a person may be cared for by a multidisciplinary team, including a gastroenterologist, dietitian, and allergist. Common treatment options include:

Medicines for UC

Medications are usually the first-line treatment for UC. Doctors can prescribe aminosalicylates, which reduce inflammation in the lining of the gastrointestinal tract.

Other medications a doctor may prescribe include:

  • corticosteroids
  • immunomodulators
  • Organic Products
  • small molecule targeted drugs

Diet for UC

UC treatment also focuses on diet, controlling inflammation, and regulating the immune system.

Although diet therapy can be effective, UC will likely also require medication, or a combination of medications, in conjunction with diet changes.

Learn more about foods to eat and avoid with UC.

UC surgery

A doctor may recommend surgery in cases of UC where medications no longer manage the condition. UC surgery may involve removing the entire colon, called a colectomy.

A person with the disease may need emergency surgery if there is a blockage or perforation in the colon.

Learn more about UC treatment.

Because CE is a rare condition that doctors do not fully understand, there is no clearly established set of treatment procedures like for UC. The goal of treatment is to reduce inflammation and damage due to eosinophils.

Diet therapy for EC

One treatment option for EC is to eliminate potential trigger foods from a person’s diet. A dietician can help individuals understand which foods to cut out and how to make the diet sustainable and nutritious.

Doctors can only identify a few foods that cause the problem in some people, especially infants, usually milk or soy. Once a parent or caregiver removes these foods from a child’s diet, EC usually goes away.

Medications for EC

Besides diet therapy, the other main treatment method for CE involves corticosteroids, which aim to reduce swelling and inflammation.

Prednisolone is usually the corticosteroid of first choice for eosinophilic gastrointestinal disease. It is effective in more 90% of cases.

In cases that do not respond to these first-line treatments, a doctor may consider using drugs that manipulate the immune system. For example, a Case Study 2021 found that montelukast, a leukotriene receptor antagonist for the treatment of asthma, was an effective first-line treatment for CE with or without steroids.

Surgery is not often a treatment option for CE, except in severe cases with colonic obstruction that could be dangerous.

Because CE is very rare and difficult to diagnose, research on the effectiveness of these treatments is sparse, but shows promise in managing the disease.

CE in infants is often benign, with a prognosis usually very positive. It will often resolve spontaneously, with children being able to tolerate the implicated foods within a few years.

In adults, UC and CE tend to become chronic. A person is likely to experience flare-ups and periods of apparent remission. Doctors may recommend routine monitoring involving follow-up colonoscopies or blood and stool tests in these cases.

Although UC and CE have very similar symptoms and both tend to be chronic, they are separate conditions that require slightly different treatment and management.

Although UC is a lifelong disease, there are many treatment options that can help people manage their symptoms and improve their quality of life.

CE is a very rare condition, but it can resolve in children by removing trigger foods. Ongoing research aims to better understand the disease and show promising treatment options.

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