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Noninfectious colitis associated with short gut syndrome in infants
S F Taylor1, J M Sondheimer, R J Sokol
1Department of Pediatrics, University of Colorado School of Medicine, Denver.
Insights
Noninfectious bloody diarrhea in infants with short bowel syndrome is linked to carbohydrate malabsorption and specific formulas. Reducing formula intake or using sulfasalazine can resolve symptoms.
Area of Science:
- Pediatric Gastroenterology
- Neonatology
- Clinical Nutrition
Background:
- Short bowel syndrome (SBS) necessitates parenteral nutrition (PN) but also poses risks for gastrointestinal complications.
- Enteral feeding advancements in SBS infants can precipitate new clinical challenges.
- Bloody diarrhea is a concerning symptom in infants requiring specialized nutritional support.
Purpose of the Study:
- To describe the clinical characteristics, endoscopic findings, and treatment outcomes of noninfectious bloody diarrhea in infants with SBS.
- To identify potential triggers and effective management strategies for this condition.
Main Methods:
- Retrospective case series of 16 infants with SBS on PN over 33 months.
- Clinical data collection including stool characteristics, age at onset, and feeding regimens.
- Endoscopic evaluation (sigmoidoscopy) and colonic biopsies in affected infants.
- Analysis of treatment interventions and their impact on rectal bleeding.
Main Results:
- 13 of 16 infants developed noninfectious bloody diarrhea, characterized by bloody, watery stools and carbohydrate malabsorption.
- Colitis onset occurred around 4.2 months of age, coinciding with increased enteral feedings of hydrolyzed protein/amino acid formulas.
- Endoscopy showed edema, erythema, and friability; biopsies revealed eosinophilia in the lamina propria.
- Rectal bleeding resolved with decreased or withheld formula; sulfasalazine demonstrated the most significant improvement.
Conclusions:
- Noninfectious bloody diarrhea is a notable complication in infants with SBS managed with PN, associated with specific enteral formulas and carbohydrate malabsorption.
- Management involves adjusting enteral formula intake and can be effectively treated with medications like sulfasalazine.
- These findings aid in the diagnosis and management of gastrointestinal bleeding in this vulnerable infant population.
Abstract:
We describe noninfectious bloody diarrhea in 13 of 16 infants referred for management of short bowel syndrome and parenteral nutrition during a 33-month period. The condition was characterized by bloody, watery stools associated with carbohydrate malabsorption. Colitis occurred at a mean age of 4.2 months during periods of advancing enteral feedings of a hydrolyzed protein- or amino acid-containing formula. Sigmoidoscopy performed in nine patients revealed edema, patchy erythema, loss of normal vascular pattern, and mucosal friability without ulcerations or pseudomembranes. Colonic biopsy specimens demonstrated edema and mixed hypercellularity of the lamina propria, with prominent eosinophilia. Rectal bleeding ceased if formula feedings were decreased or withheld. Of multiple medications administered, sulfasalazine seemed to improve rectal bleeding most effectively in our patients and allowed for more rapid reintroduction of enteral feedings.