Conclusions

This case describes an early-onset, Crohn-like chronic colitis phenotype in a child with an allergic history, histamine-pathway variants, barrier activation markers, and impaired mastication/digestive processing. Over approximately two years, a structured, nonimmunosuppressive, gut-focused multimodal strategy was associated with resolution of hematochezia, improvement of stool inflammatory biomarkers, and near-complete mucosal healing on repeat colonoscopy. The case is hypothesis-generating and supports further prospective study of phenotype-directed, stepwise approaches in selected pediatric chronic colitis presentations.