Allergic proctitis and abdominal distention mimicking Hirschsprung's disease in infants

Lee, Jee Hyun; Choe, Yon Ho; Lee, Suk-Koo; Seo, Jeong Meen; Kim, Ji Hye; Suh, Yeon‐Lim

doi:10.1111/j.1651-2227.2007.00536.x

Cited by 17 publications

(10 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However several studies have noted variable sensitivity, specificity, positive and negative predictive values in the diagnosis of Hirschsprung disease 59-64. Furthermore, false positive results may occur due to immaturity of ganglion cells (in premature babies) and artefacts 61. Therefore in cases with strong clinical suspicion of Hirschsprung disease, it is imperative to perform a suction biopsy to confirm or exclude the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management

Rajindrajith¹,

Devanarayana²

2011

J Neurogastroenterol Motil

123

View full text Add to dashboard Cite

Constipation in children is a common health problem affecting 0.7% to 29.6% children across the world. Exact etiology for developing symptoms is not clear in children and the majority is considered to have functional constipation. Alteration of rectal and pelvic floor function through the brain-gut axis seems to play a crucial role in the etiology. The diagnosis is often a symptom-based clinical process. Recently developed Rome III diagnostic criteria looks promising, both in clinical and research fields. Laboratory investigations such as barium enema, colonoscopy, anorectal manometry and colonic transit studies are rarely indicated except in those who do not respond to standard management. Treatment of childhood constipation involves several facets including education and demystification, toilet training, rational use of laxatives for disimpaction and maintenance and regular follow-up. Surgical options should be considered only when medical therapy fails in long standing constipation. Since most of the management strategies of childhood constipation are not evidence-based, high-quality randomized controlled trials are required to assess the efficacy of currently available or newly emerging therapeutic options. Contrary to the common belief that children outgrow constipation as they grow up, a sizable percentage continue to have symptoms beyond puberty.

show abstract

Section: Discussionmentioning

confidence: 99%

Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management

Rajindrajith¹,

Devanarayana²

2011

J Neurogastroenterol Motil

123

View full text Add to dashboard Cite

show abstract

“…Infants with cow's milk allergic constipation typically present with infrequent bowel movements from the first weeks of life or after the dietary introduction of cow's milk-based products. In severe cases, this symptom may be associated with significant abdominal distension and should be distinguished from Hirschsprung's disease by rectal suction biopsy [34] . In some cases, eosinophilic proctocolitis can be demonstrated [32] .…”

Section: Constipationmentioning

confidence: 99%

Gastrointestinal Food Allergies

Heine¹

2015

Chemical Immunology and Allergy

View full text Add to dashboard Cite

Gastrointestinal food allergies present during early childhood with a diverse range of symptoms. Cow's milk, soy and wheat are the three most common gastrointestinal food allergens. Several clinical syndromes have been described, including food protein-induced enteropathy, proctocolitis and enterocolitis. In contrast with immediate, IgE-mediated food allergies, the onset of gastrointestinal symptoms is delayed for at least 1-2 hours after ingestion in non-IgE-mediated allergic disorders. The pathophysiology of these non-IgE-mediated allergic disorders is poorly understood, and useful in vitro markers are lacking. The results of the skin prick test or measurement of the food-specific serum IgE level is generally negative, although low-positive results may occur. Diagnosis therefore relies on the recognition of a particular clinical phenotype as well as the demonstration of clear clinical improvement after food allergen elimination and the reemergence of symptoms upon challenge. There is a significant clinical overlap between non-IgE-mediated food allergy and several common paediatric gastroenterological conditions, which may lead to diagnostic confusion. The treatment of gastrointestinal food allergies requires the strict elimination of offending food allergens until tolerance has developed. In breast-fed infants, a maternal elimination diet is often sufficient to control symptoms. In formula-fed infants, treatment usually involves the use an extensively hydrolysed or amino acid-based formula. Apart from the use of hypoallergenic formulae, the solid diets of these children also need to be kept free of specific food allergens, as clinically indicated. The nutritional progress of infants and young children should be carefully monitored, and they should undergo ongoing, regular food protein elimination reassessments by cautious food challenges to monitor for possible tolerance development.

show abstract

“…First reported in 2002,3 BTNIN did not receive much attention from pediatric surgeons because of its favorable clinical course, and very few supportive articles have been published 4,5. However, the age at the definitive surgery of Hirschsprung's disease is far younger than previous decade and one-stage procedure has been popular 6-8.…”

Section: Discussionmentioning

confidence: 99%

“…The one possible cause of BTNIN was allergy-related disorder 4,5. Kubota, et al4 suggest that cow's milk allergy is the main cause of BTNIN.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of these patients had symptom relief after conversion to formula. Allergic proctitis, a specific form of cow's milk allergy, could induce symptoms mimicking Hirschsprung's disease 5. Eosinophilic infiltration and inflammatory cell infiltration in the lamina propria of rectum have been identified, and rectal suction biopsy is very useful to differentiate this from other disorders.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Characteristics and Management of Benign Transient Non-Organic Ileus of Neonates: A Single-Center Experience

et al. 2014

View full text Add to dashboard Cite

PurposeThe term benign transient non-organic ileus of neonates (BTNIN) is applied to neonates who present symptoms and plain radiographic findings of Hirschsprung's disease, but do not have aganglionic bowel and are managed well by conservative treatment. It can often be difficult to diagnose BTNIN because its initial symptoms are similar to those of Hirschsprung's disease. The aim of this study is to evaluate the clinical characteristics and proper treatment of BTNIN.Materials and MethodsA retrospective review was made on the clinical data of 19 neonates who were treated for BTNIN between January 2008 and December 2011 at a single facility.ResultsAbdominal distension occurred in every patient (19/19). Other common symptoms included emesis (5/19), explosive defecation (5/19), and constipation (4/19). The vast majority of patients (15/19) experienced the onset of symptoms between 2 and 4 weeks of age. Radiograph findings from all of the patients were similar to Hirschsprung's disease. A barium study showed a transition zone in 33.4% (6/18) of the patients. However, rectal biopsy revealed ganglion cells in the distal rectum in 88.2% (15/17) of the patients, and anorectal manometry showed a normal rectoanal inhibitory reflex in 90% (9/10). All patients responded well to conservative treatment. Symptoms disappeared at the mean age of 4.9±1.0 months, and the abdominal radiographs normalized.ConclusionBTNIN had an excellent outcome with conservative treatment, and must be differentiated from Hirschsprung's disease. A rectal biopsy and anorectal manometry were useful diagnostic tools in the differential diagnosis.

show abstract

Allergic proctitis and abdominal distention mimicking Hirschsprung's disease in infants

Cited by 17 publications

References 25 publications

Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management

Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management

Gastrointestinal Food Allergies

Clinical Characteristics and Management of Benign Transient Non-Organic Ileus of Neonates: A Single-Center Experience

Contact Info

Product

Resources

About