Introduction

Early-onset inflammatory bowel disease (IBD) includes children who develop chronic intestinal inflammation during the first decade of life [1,2]. In this age group, phenotypes may overlap with food allergy, barrier dysfunction, and microbiota disturbances [3]. A subset of patients also exhibit features consistent with impaired histamine degradation capacity, which may contribute to gastrointestinal symptoms and mucosal immune activation [4-7].

In parallel, oral-phase dysfunction can be clinically relevant in selected children with chronic gastrointestinal complaints. Rapid swallowing, limited chewing, and restricted texture acceptance can increase delivery of larger food particles and incompletely processed macromolecules to the distal gut [7-10]. This may augment luminal antigen exposure and fermentation load and may worsen barrier stress in susceptible hosts [11].

We report a child with chronic colitis of Crohn-like phenotype and long-standing hematochezia who also had allergic features, impaired mastication/digestive processing, elevated stool histamine, and histamine-pathway genetic variants. The case describes a structured, nonimmunosuppressive, gut-focused multimodal approach and subsequent clinical and endoscopic evolution. This case report was prepared in accordance with the Case Report (CARE) reporting guideline, and a completed CARE checklist is provided as a supplementary material.