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Food-induced eosinophilic proctocolitis
1Johns Hopkins University School of Medicine, Lutherville, Maryland 21093, USA.
Insights
Food-induced eosinophilic proctocolitis in infants presents with bloody stools but lacks systemic symptoms. Dietary protein elimination, via formula or maternal diet, resolves bleeding within days, offering an excellent long-term prognosis.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Allergy
Background:
- Food-induced eosinophilic proctocolitis is a condition affecting infants, typically within the first two months of life.
- Characterized by blood-tinged stools, it often presents in exclusively breastfed infants, distinguishing it from other food-induced inflammatory bowel diseases.
- Systemic symptoms like emesis, failure to thrive, anemia, and severe diarrhea are generally absent.
Purpose of the Study:
- To describe the clinical presentation, diagnostic findings, and treatment outcomes of food-induced eosinophilic proctocolitis.
- To highlight the diagnostic features on proctoscopy and rectal biopsy.
- To evaluate the efficacy of dietary elimination strategies in managing this condition.
Main Methods:
- Clinical observation of infants presenting with blood-tinged stools.
- Proctoscopic examination of the rectosigmoid.
- Rectal and lower sigmoid biopsies to assess eosinophilic infiltration.
- Dietary intervention involving extensively hydrolyzed casein-based formula or maternal dietary protein elimination.
Main Results:
- Proctoscopy revealed focal erythema, erosions, and/or nodularity of lymphoid nodular hyperplasia.
- Rectal biopsies showed characteristic eosinophilic infiltration of the mucosa and lamina propria (typically >6-10 eosinophils/high-powered field).
- Clinical resolution of bleeding occurred within 72-96 hours following dietary protein elimination.
Conclusions:
- Food-induced eosinophilic proctocolitis is a distinct entity characterized by rectal bleeding in young infants.
- Diagnosis is supported by endoscopic and histological findings of eosinophilic infiltration.
- Dietary management is highly effective, leading to rapid symptom resolution and an excellent long-term prognosis with tolerance of unrestricted diets by one year of age.
Abstract:
Food-induced eosinophilic proctocolitis appears in the first 2 months of life with blood-tinged stools. Aside from occasional apparent pain on defecation and a few infants with moderate eczema, systemic features are absent. Indeed, aside from the diaper, the infant is generally described as well. Thus, in contrast to the infant with enterocolitis, features such as emesis, failure to thrive, significant anemia, and dramatic diarrhea are not seen. In contrast to infants with the other food-induced inflammatory diseases of the bowel, most symptomatic infants are exclusively breast fed. Proctoscopic examination reveals focal erythema, erosions, and/or the nodularity of lymphoid nodular hyperplasia of the rectosigmoid. Biopsies of the rectum and lower sigmoid reveal a characteristic infiltration of the mucosa and lamina propria with eosinophils, usually in excess of 6 to 10 per high powered field. Elimination of the offending protein from the diet of the infant, through use of an extensively hydrolyzed casein-based formula or the elimination of the protein from the diet of the mother of the breast-feeding infant, leads to clinical resolution of the bleeding within 72 to 96 hours. By 1 year of age the infants routinely tolerate an unrestricted diet, and the long term prognosis is excellent.