Advanced Criteria for Clinicopathological Diagnosis of Food Protein-induced Proctocolitis

Abstract

The clinicopathological findings in previous studies concerning food protein-induced proctocolitis (FPIPC) are quite diverse in terms of results and conclusions. The aim of this study was to suggest advanced clinicopathological diagnostic criteria that facilitate the early confirmation of FPIPC. Data of 38 FPIPC patients, who had received sigmoidoscopy and biopsy, was analyzed. Microscopic findings were compared with observations of previous studies. Feeding at onset of bleeding was exclusively breast-fed (94.7%) and formula-fed or mixed-fed (5.3%). Endoscopic abnormalities were observed in all patients; nodular hyperplasias with circumscribed and/or central pit-like erosions in 94.7% and erythema in 5.3%. Histopathological findings were; lymphoid aggregates in 94.7%, eosinophils in lamina propria of ≥60 cells/10 HPF in 97.4% and of >20 cells/HPF in 63.2%, epithelial or muscularis mucosa eosinophil infiltration in 97.4%, and crypt abscess in 2.6%. The majority of FPIPC patients are exclusively breast-fed and nodular hyperplasias with erosions may be a disease specific endoscopic finding. Histologic diagnosis of FPIPC is compatible with eosinophils in the lamina propria of ≥60 cells/10 high power fields; however, >20 cells/HPF is not an appropriate diagnostic criterion.

Can Fecal Calprotectin Level Be Used as a Markers of Inflammation in the Diagnosis and Follow-Up of Cow's Milk Protein Allergy?

“…The symptoms that suggest CMPA are observed in 5%-15% of infants; however, the incidence of CMPA is approximately 2%-5% when specific diagnostic criteria are used. In most patients, the symptoms develop before 1 year of age and within 1 week after the intake of cow's milk 2,3. Food allergies are classified in 2 groups: IgE-mediated and non-IgE-mediated allergy 4.…”

Malabsorption Syndrome. Ambulance Clinical Events

“…Нет сомнения в том, что невозможно создать универсальную элиминационную диету для всех детей с пищевой аллергией, но бесспорным остается факт, что эффективность лечения зависит от своевременного и полного исключения из рациона ребенка и/или кормя-щей матери всех причинно-значимых аллергенов [6][7][8]. Кроме того, тяжесть течения заболевания и, что самое главное, прогноз зависят от своевременной и полной элиминации аллергенов из пищи и быта ребенка с аллер-гической патологией [9][10][11].…”

Diagnosing Eosinophilic Colitis: Histopathological Pattern or Nosological Entity?

“…A density of greater than 60 eosinophils/10 HPF has been suggested [20, 21] though this is below the mean levels found at autopsy in children without known colonic disease [14]. Others have adopted 30/HPF [22], a figure which, though corresponding with a histologically conspicuous eosinophilic infiltrate, would be expected to include some normal cases: Lowichick and Weinberg found a mean of 17 eosinophils/HPF (89/mm 2 ) and observed up to 52/HPF in individuals with no known gastrointestinal disease, and DeBrosse and others found up to 50 eosinophils/HPF in apparently normal colons (Table 1).…”