Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood

Pumberger, W.; Pomberger, Gerhard; Geissler, William B.

doi:10.1136/pmj.77.906.252

Cited by 41 publications

(26 citation statements)

References 11 publications

(8 reference statements)

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“…However, the clinical, endoscopic, and histopathological findings in previous studies (7-12) associated with FPIPC are quite different in terms of results and conclusions, and also with our clinical experiences of FPIPC patients.…”

Section: Introductioncontrasting

confidence: 71%

Advanced Criteria for Clinicopathological Diagnosis of Food Protein-induced Proctocolitis

et al. 2007

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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.

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Section: Introductioncontrasting

confidence: 71%

Advanced Criteria for Clinicopathological Diagnosis of Food Protein-induced Proctocolitis

et al. 2007

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“…Although the benign nature of rectal bleeding was previously demonstrated, iron deficiency anemia and hypoalbuminemia could be associated findings (18)(19)(20)(25)(26)(27). Arvola et at have found hemoglobin levels <10.5 g/dl in 18% of their infants on admission and in only 3% at 1 yr of age, but this includes both infants who continued with elimination diet and those who resumed CMP.…”

Section: Discussionmentioning

confidence: 96%

Cow's milk associated rectal bleeding: a population based prospective study

Elizur

Cohen

Goldberg

et al. 2012

Pediatric Allergy Immunology

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“…Children with proctocolitis do not have growth delay or poor weight gain. Occasionally, infants may be slightly anemic (5), with hypoalbuminemia being a rare manifestation (6). On examination, the abdomen is benign.…”

Section: Allergic Proctocolits Discussionmentioning

confidence: 99%

Educational clinical case series for pediatric allergy and immunology: Allergic proctocolitis, food protein‐induced enterocolitis syndrome and allergic eosinophilic gastroenteritis with protein‐losing gastroenteropathy as manifestations of non‐IgE‐mediated cow's milk allergy

Maloney

Nowak‐Węgrzyn

2007

Pediatric Allergy Immunology

124

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Cow's milk protein allergy is the most common food allergy in infants and young children. It is estimated that up to 50% of pediatric cow's milk allergy is non-IgE-mediated. Allergic proctocolitis is a benign disorder manifesting with blood-streaked stools in otherwise healthy-appearing infants who are breast- or formula-fed. Symptoms resolve within 48-72 h following elimination of dietary cow's milk protein. Most infants tolerate cow's milk by their first birthday. Food protein-induced enterocolitis syndrome presents in young formula-fed infants with chronic emesis, diarrhea, and failure to thrive. Reintroduction of cow's milk protein following a period of avoidance results in profuse, repetitive emesis within 2-3 h following ingestion; 20% of acute exposures may be associated with hypovolemic shock. Treatment of acute reactions is with vigorous hydration. Most children become tolerant with age; attempts of re-introduction of milk must be done under physician supervision and with secure i.v. access. Allergic eosinophilic gastroenteritis affects infants as well as older children and adolescents. Abdominal pain, emesis, diarrhea, failure to thrive, or weight loss are the most common symptoms. A subset of patients may develop protein-losing enteropathy. Fifty percent of affected children are atopic and have evidence of food-specific IgE antibody but skin prick tests and serum food-IgE levels correlate with response to elimination diet poorly. Elemental diet based on the amino-acid formula leads to resolutions of gastrointestinal eosinophilic inflammation typically within 6 wk.

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Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood

Cited by 41 publications

References 11 publications

Advanced Criteria for Clinicopathological Diagnosis of Food Protein-induced Proctocolitis

Advanced Criteria for Clinicopathological Diagnosis of Food Protein-induced Proctocolitis

Cow's milk associated rectal bleeding: a population based prospective study

Educational clinical case series for pediatric allergy and immunology: Allergic proctocolitis, food protein‐induced enterocolitis syndrome and allergic eosinophilic gastroenteritis with protein‐losing gastroenteropathy as manifestations of non‐IgE‐mediated cow's milk allergy

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