Allergic colitis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Qasim Salau, M.B.B.S., FMCPaed [2]

Overview

Symptoms and signs of allergic colitis are non-specific and seen in other causes of colitis and some systemic diseases. Detailed history and physical examination is needed to make the diagnosis. In addition, endoscopy with biopsy may be required to confirm the diagnosis. In infancy, allergic colitis must particularly be differentiated from necrotizing enterocolitis, infectious colitis, anal fissure, intussusception and volvolus. In adolescent and adults, allergic colitis must be differentiated from inflammatory bowel disease, infectious colitis, and colorectal malignancy.

Differentiating Allergic colitis from other Diseases

The differential diagnosis of allergic colitis can be classified into two according to age group.

Differential diagnosis in Infants

• Swallowed maternal blood syndrome
• Anorectal fissure
• Necrotizing enterocolitis especially in preterm babies
• Vitamin K deficiency hemorrhage
• Other Coagulopathies (hereditary such as coagulation factor deficiency or acquired such as Liver disease with clotting factor deficiency)
• Intussusception
• Infectious colitis
• Hirschsprung disease complicated by enterocolitis
• Volvolus
• Inflammatory bowel disease(early onset)
• Meckel diverticulum
• Dermatitis
• Gastrointestinal duplication cyst
• Vascular malformations
• Gastro-duodenal ulcers
• Lymphonodular hyperplasia

Differential diagnosis in adolescent/ adult

• Inflammatory bowel disease
• Behcet's disease
• Arteriovenous malformation
• Diverticulosis
• Infectious colitis
• Coagulopathy
• Henoch-Schonlein purpura
• Systemic lupus erythematosus(SLE)
• Colorectal malignancy

• The symptoms of colitis such as diarrhea especially bloody diarrhea and abdominal pain are seen are seen in all forms of colitis. The table below lists the differential diagnosis of common causes of colitis:

Diseases	History and Symptoms				Physical Examination				Laboratory findings
	Diarrhea	Rectal bleeding	Abdominal pain	Atopy	Dehydration	Fever	Hypotension	Malnutrition	Blood in stool (frank or occult)	Microorganism in stool	Pseudomembranes on endoscopy	Lab Test 4
Allergic Colitis	+	++	+	++					++
Chemical colitis	+	++	++		+	+			++		+
Infectious colitis	++	++	++		+++	+++	++	+	++	++	+
Radiation colitis	+	++	+		+			+	++
Ischemic colitis	+	+	++		+	+	+	+	++
Drug-induced colitis	+	+	++			+			++		+