73 yo woman with asthma and anxiety. Colonoscopy is done for chronic diarrhea. Altered mucosal nodularity in the ascending colon was noted on both WL and NBI.

73 yo woman with asthma and anxiety. Colonoscopy is done for chronic diarrhea. Altered mucosal nodularity in the ascending colon was noted on both WL and NBI.

I’d like to mention six main possibilities:

1. Lots of elderly patients with diarrhea suffer from microscopic colitis, which is not really microscopic (there are generally some endoscopic findings such as edema, granularity or segments patches of irregular mucosa). See classic study by Koulaouzidis et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411381/​

2. Asthma may lead to inflammatory bowel disease. But this would be uncommon in a 73-year-old. Still possible.

3. The patient may not have real asthma and she might be suffering from vasculitis (e.g. Churg Strauss)

4. Colitis may also be infectious. Ascaris lumbricoides leads to Löffler’s pneumonia.

5. Strongyloides stercoralis induces eosinophilic colitis or gastroenteritis and has been reported in the USA, especially in those patients taking immunosuppressants or steroids. https://www.giejournal.org/article/S0016-5107(04)00337-2/fulltext

6. Eosinophilic colitis is another possibility, idiopathic or medication 💊 induced.

• I think the differential blood count and the histologic results will help us secure the final diagnosis.