Brief Article
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World J Gastroenterol. Jun 28, 2013; 19(24): 3824-3830
Published online Jun 28, 2013. doi: 10.3748/wjg.v19.i24.3824
Characteristics of allergic colitis in breast-fed infants in the absence of cow’s milk allergy
Kriszta Molnár, Petra Pintér, Hajnalka Győrffy, Áron Cseh, Katalin Eszter Müller, András Arató, Gábor Veres
Kriszta Molnár, Petra Pintér, Áron Cseh, Katalin Eszter Müller, András Arató, Gábor Veres, 1st Department of Pediatrics, Semmelweis University, 1083 Budapest, Hungary
Hajnalka Győrffy, 2nd Department of Pathology, Semmelweis University, 1091 Budapest, Hungary
Author contributions: Molnár K and Pintér P contributed equally to the writing of this paper; Veres G designed the research; Arató A and Veres G enrolled the patients; Molnár K, Pintér P, Cseh Á and Müller KE performed the analyses; Győrffy H analyzed the histological data; Molnár K, Pintér P and Veres G wrote the paper; Arató A critically reviewed the paper.
Supported by OTKA-K105530, -K81117 and ETT-028-02; the János Bolyai Research Grant, to Veres G; and the János Bolyai Research Scholarship of the Hungarian Academy of Sciences
Correspondence to: Gábor Veres, MD, PhD, 1st Department of Pediatrics, Semmelweis University, Bókay u 53, 1083 Budapest, Hungary. veres.gabor@med.semmelweis-univ.hu
Telephone: +36-20-8258163 Fax: +36-1-3036077
Received: October 4, 2012
Revised: February 5, 2013
Accepted: March 23, 2013
Published online: June 28, 2013
Abstract

AIM: To investigate the characteristics of mucosal lesions and their relation to laboratory data and long-term follow up in breast-fed infants with allergic colitis.

METHODS: In this study 31 breast-fed infants were prospectively evaluated (mean age, 17.4 wk) whose rectal bleeding had not ceased after a maternal elimination diet for cow’s milk. Thirty-four age-matched and breast-fed infants (mean age, 16.9 wk) with no rectal bleeding were enrolled for laboratory testing as controls. Laboratory findings, colonoscopic and histological characteristics were prospectively evaluated in infants with rectal bleeding. Long-term follow-up with different nutritional regimes (L-amino-acid based formula or breastfeeding) was also included.

RESULTS: Iron deficiency, peripheral eosinophilia and thrombocytosis were significantly higher in patients with allergic colitis in comparison to controls (8.4 ± 3.2 μmol/L vs 13.7 ± 4.7 μmol/L, P < 0.001; 0.67 ± 0.49 G/L vs 0.33 ± 0.17 G/L, P < 0.001; 474 ± 123 G/L vs 376 ± 89 G/L, P < 0.001, respectively). At colonoscopy, lymphonodular hyperplasia or aphthous ulceration were present in 83% of patients. Twenty-two patients were given L-amino acid-based formula and 8 continued the previous feeding. Time to cessation of rectal bleeding was shorter in the special formula feeding group (mean, 1.4 wk; range, 0.5-3 wk) when compared with the breast-feeding group (mean, 5.3 wk; range, 2-9 wk). Nevertheless, none of the patients exhibited rectal bleeding at the 3-mo visit irrespective of the type of feeding. Peripheral eosinophilia and cessation of rectal bleeding after administration of elemental formula correlated with a higher density of mucosal eosinophils.

CONCLUSION: Infant hematochezia, after cow’s milk allergy exclusion, is generally a benign and probably self-limiting disorder despite marked mucosal abnormality. Formula feeding results in shorter time to cessation of rectal bleeding; however, breast-feeding should not be discouraged in long-lasting hematochezia.

Keywords: Rectal bleeding, Breast-feeding, Allergic colitis, Colonoscopy, Amino-acid formula

Core tip: Rectal bleeding is a common problem in otherwise healthy breast-fed infants; our primary aim was to find characteristic lesions at colonoscopy and determine the cessation of rectal bleeding when administering different nutritional regimes (L-amino-acid based formula or breast-feeding). Our secondary aim was to find correlations between laboratory data, severity of mucosal lesions and cessation of rectal bleeding in allergic colitis infants with no cow’s milk allergy.