Hemorrhagic gastritis due to cow's milk allergy: report of two cases

Abstract

Artigo submetido em 17.02.03, aceito em 28.05.03. Resumo Objetivo: descrever dois lactentes com gastrite hemorrágica, devido à alergia ao leite de vaca. Descrição dos casos: ambos os pacientes apresentavam hematêmese, vômitos e desnutrição. Os pacientes apresentavam infiltrado eosinofílico em mucosa gástrica biopsiada e resolução dos sintomas após o início de dieta com exclusão da proteína do leite de vaca. Comentários: gastrite hemorrágica devido à alergia ao leite de vaca é um diagnóstico incomum. Até o momento foram relatados 10 pacientes com gastrite alérgica, e as principais manifestações clínicas são vômitos, desnutrição, anemia e hematêmese. A gastrite por alergia ao leite de vaca pode apresentar-se em diferentes graus de gravidade, e pode ser subdiagnosticada em muitos pacientes. A menos que o tratamento correto seja iniciado, o paciente desenvolverá desnutrição protéico-calórica grave e anemia. Doença alérgica do trato gastrointestinal superior deve ser considerada em todos os lactentes com vômitos recorrentes, particularmente se complicado com hematêmese. O diagnóstico de gastrite alérgica é clínico, auxiliado pela endoscopia e anatomia patológica.

ARPC1B Mutation Manifesting as Recurrent Hematemesis With Metaplasia

“…The mucosal changes in these patients were attributed to hypergastrinemia from chronic renal failure. Hemorrhagic gastritis secondary to cow’s milk protein allergy, treated with milk protein exclusion, has been described ( 5 ); its pathophysiology is most similar to that of ARPC1B mutation in our patient. Treatment for hemorrhagic gastritis is variable and includes medical therapy with acid suppression and steroids and endoscopic therapies like bipolar cautery or argon plasma coagulation ( 4 , 5 , 7 ).…”

“…Hemorrhagic gastritis secondary to cow’s milk protein allergy, treated with milk protein exclusion, has been described ( 5 ); its pathophysiology is most similar to that of ARPC1B mutation in our patient. Treatment for hemorrhagic gastritis is variable and includes medical therapy with acid suppression and steroids and endoscopic therapies like bipolar cautery or argon plasma coagulation ( 4 , 5 , 7 ). Our patient was successfully treated with simultaneous nutritional and endoscopic therapy.…”

“…Hemorrhagic gastritis is infrequently encountered in children, and reported cases have documented a variety of etiologies including viral infections, oncologic infiltrates, non-steroidal anti-inflammatory drug use and hypergastrinemia, and cow's milk protein allergy (4)(5)(6). In a study of 19 children with chronic renal failure who underwent endoscopy and measurement of serum gastrin levels, hemorrhagic gastritis was the most common abnormal endoscopic finding, seen in 31.5% (6).…”

Cow’s milk-induced gastrointestinal disorders: From infancy to adulthood

“…It can be treated with proton-pump inhibitors, but dietary treatment is the cornerstone of therapy after confirming the diagnosis with endoscopy and a 4- to 12-wk elimination test. The dietary approaches involve amino acid-based formula, allergy testing-based directed diet, or empirical six-food elimination diet (milk, soy, wheat, eggs, fish/seafood, and peanut/nuts)[ 34 , 35 ].…”