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Colon mucosal pathology in infants under three months of age with diarrhea disorders
Jei-Wen Chang1, Tzee-Chung Wu, Ke-Sheng Wang
1Division of Gastroenteroly and Nutrition, Children's Medical Center, Taipei Veterans General Hospital, Taiwan.
Insights
Sigmoidoscopy and biopsy aid in diagnosing infant diarrhea. Eosinophilic colitis, often allergy-related, is common in infants with unexplained diarrhea and improves with dietary changes.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Endoscopy
- Infant Pathology
Background:
- Infant diarrhea presents diagnostic challenges.
- Early infancy diarrhea can lead to severe outcomes.
- Sigmoidoscopy with biopsy aids in diagnosis.
Purpose of the Study:
- Evaluate colon mucosal pathology in infants with unknown diarrhea.
- Determine clinical courses of different diarrhea etiologies.
Main Methods:
- Retrospective analysis of 64 infants (mean age 1.68 months).
- All infants underwent fiberoptic sigmoidoscopy and mucosal biopsy.
- Diagnosis of unknown diarrhea disorder after initial investigation.
Main Results:
- Endoscopic findings included edema (56.2%), nodularity (46.8%), and erythema (35.9%).
- Pathology revealed eosinophilic colitis (EC) in 62.5% and nonspecific colitis in 29.7%.
- EC patients showed higher eosinophils in stool (81.5%) and responded to formula changes (81.5%).
Conclusions:
- Sigmoidoscopy and biopsy are valuable for diagnosing infant diarrhea.
- Eosinophilic colitis is a frequent cause of infant diarrhea, suggesting allergy.
- Dietary elimination of allergens significantly improves allergic colitis.
Background:
Diarrhea is a common disease in infants. It may result in catastrophic events, especially in early infancy. Sometimes it is difficult to point out the diagnosis after initial examination. Sigmoidoscopy with mucosal biopsy may help in assessing the nature of the disease. The goals of this study are to evaluate the colon mucosal pathology in young infants with unknown diarrhea disorders and the clinical courses of different etiologies.
Methods:
We performed a retrospective analysis of 64 young infants (Mean +/- SD: 1.68 +/- 1.01 months) in whom a diagnosis of unknown diarrhea disorder had been made after an initial investigation. All infants received fiberoptic sigmoidoscopy and mucosal biopsy with consent obtained.
Results:
The appearance of the colon mucosa under endoscopy were: 36 (56.2%) showing edema, 30 (46.8%) showing nodularity, 23 (35.9%) patients with focal erythema and friable mucosa, 11 (17.1%) showed erosion, 7 (10.9%) patients showing hemorrhage, and negative finding in one patient (1.6%). Colon mucosa pathologic findings were established: 40 (62.5%) had eosinophilic colitis (EC) and 19 (29.7%) had nonspecific colitis. The biopsies were normal in 5 cases; 81.5%(22/27) of patients with EC showed eosinophils in the stool smear which was significantly higher ( = 0.04) compared to the group II (9/17); 34 of 40 EC patients responded rapidly to changes in formula.
Conclusion:
Sigmoidoscopy and mucosal biopsy may be useful in the pathologic diagnosis of unknown diarrhea disorders. Eosinophilic colitis accounts for over half of very young infants with diarrhea disorders suggesting for allergic etiology. Patients with allergic colitis may exhibit a dramatic response to elimination of the offending proteins from the diet.