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Published on: August 7, 2017

Prevalence and outcome of allergic colitis in healthy infants with rectal bleeding: a prospective cohort study

Stavra A Xanthakos1, Jeffrey B Schwimmer, Hector Melin-Aldana

  • 1Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Ohio 45229-3039, USA.

Journal of Pediatric Gastroenterology and Nutrition
|July 2, 2005
PubMed

Insights

Allergic colitis may be overdiagnosed in infants with rectal bleeding. Many infants with bleeding, even without allergic colitis, improve without dietary changes, avoiding unnecessary treatments.

Area of Science:

  • Pediatric Gastroenterology
  • Allergy and Immunology
  • Infant Health

Background:

  • Allergic colitis is frequently diagnosed clinically in infants presenting with rectal bleeding.
  • Diagnosis often leads to costly hypoallergenic formula or maternal diet changes.
  • The actual prevalence of allergic colitis remains undetermined.

Purpose of the Study:

  • To test the hypothesis that allergic colitis is overdiagnosed in healthy infants with rectal bleeding.
  • To determine if rectal bleeding in infants without allergic colitis resolves without dietary intervention.

Main Methods:

  • Defined allergic colitis histologically by eosinophil presence in colonic biopsies.
  • Surveyed pediatric gastroenterologists on their standard practices for evaluating infant rectal bleeding.
  • Recruited infants under 6 months with rectal bleeding for flexible sigmoidoscopy and biopsies.
  • Monitored resolution of rectal bleeding in infants with and without allergic colitis over 9 weeks.

Main Results:

  • 84% of surveyed physicians empirically changed infant diets for presumed allergic colitis.
  • Only 64% of infants with rectal bleeding in the study met the histological criteria for allergic colitis.
  • Rectal bleeding resolved in most infants without allergic colitis, even without dietary changes.

Conclusions:

  • A substantial number of infants with rectal bleeding may be misdiagnosed with allergic colitis.
  • Unnecessary and expensive dietary changes can be avoided by accurate diagnosis.
  • Avoiding unnecessary interventions supports continued breastfeeding in infants.
Abstract

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