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Allergic gastroenteropathy in preterm infants
M A D'Netto1, V C Herson, N Hussain
1Division of Neonatology, Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT 06106, USA.
Insights
Allergic gastroenteropathy (AGE) is an under-recognized cause of gastrointestinal issues in preterm infants. Diagnosis via endoscopy and biopsy is safe and guides dietary management for improved outcomes.
Area of Science:
- Pediatric Gastroenterology
- Neonatology
- Allergy and Immunology
Background:
- Allergic gastroenteropathy (AGE) is a significant cause of gastrointestinal distress in infants.
- Preterm infants may be particularly susceptible to AGE due to their immature digestive systems.
- Previous studies have underestimated the prevalence of AGE in preterm populations.
Purpose of the Study:
- To investigate the clinical presentation, histopathologic findings, and outcomes of biopsy-proven AGE in preterm infants.
- To determine if AGE is a more common cause of gastrointestinal disease in preterm infants than previously recognized.
- To establish diagnostic criteria and management strategies for AGE in this vulnerable population.
Main Methods:
- A retrospective review (1992-1997) and prospective study (1998) of preterm infants (<37 weeks gestation) suspected of having AGE.
- Infants underwent endoscopy and biopsy for diagnostic confirmation.
- Clinical data, histopathologic findings, and treatment responses were analyzed.
Main Results:
- Twenty-five preterm infants were diagnosed with AGE, presenting with gastroesophageal reflux, feeding intolerance, or lower gastrointestinal bleeding.
- Positive biopsy findings were most common in infants with lower gastrointestinal bleeding.
- Fifteen infants responded to casein hydrolysate formula, while 10 required amino acid-based formula; most eventually tolerated cow's milk.
Conclusions:
- Allergic gastroenteropathy is likely an under-recognized condition in preterm infants presenting with gastrointestinal symptoms.
- Endoscopic confirmation and biopsy are safe and effective diagnostic tools for AGE.
- Dietary management, including specialized formulas, is crucial for improving outcomes in preterm infants with AGE.
Objectives:
To determine the clinical presentation, histopathologic features, and outcome of biopsy-proven allergic gastroenteropathy (AGE) in preterm infants. We hypothesized that AGE is a more frequent cause of gastrointestinal disease in this population than previously suspected.
Study Design:
The retrospective portion of the study, from 1992 to 1997, included preterm infants <37 weeks' gestation who underwent biopsy because of suspected AGE. The prospective portion, from January to December 1998, included 20 infants undergoing endoscopy and biopsy because of suspected AGE.
Results:
Twenty-five infants (12 retrospective/13 prospective) with mean gestational age of 29 weeks at birth and mean postnatal age at diagnosis of 78 days were diagnosed with AGE. Three clinical patterns of presentation were noted: group 1, gastroesophageal reflux disease (n = 5); group 2, non-specific feeding intolerance (n = 8); and group 3, lower gastrointestinal bleeding (n = 12). Ten patients had negative biopsy findings (3 retrospective/7 prospective) and had clinical features indistinguishable from those of groups 1 and 2. Patients in group 3 were most likely to have positive biopsy findings (12 of 12). Fifteen patients responded to a casein hydrolysate formula, and 10 patients required an amino acid-based formula. Patients with AGE who had eosinophilic infiltration and villous atrophy took longer to recover than those with eosinophilic infiltration alone (P <.03). Subsequently, most have tolerated formula challenges and are currently tolerating cow's milk.
Conclusions:
AGE may be an under-recognized cause of gastrointestinal symptoms in preterm infants. Confirmation with endoscopy and biopsy can be done safely and provides the basis for appropriate dietary management.