Related Experiment Video
Updated: May 1, 2026
Diagnosis of Hirschsprung's Disease by Immunostaining Rectal Suction Biopsies for Calretinin, S100 Protein and Protein Gene Product 9.5
Published on: April 26, 2019
Outcome of infants presenting rectal bleeding: a retrospective study in a single institution
Mari Mori1, Yoshikazu Ohtsuka1, Asuka Ishida1
1Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Insights
Rectal bleeding in infancy (RBI) due to food-protein-induced proctocolitis (FPIP) and neonatal transient eosinophilic colitis (NTEC) share similar inflammatory pathways. Interleukin-6, CCL11, and CXCL13 are key in RBI pathogenesis, with milk allergy being an uncommon outcome.
Area of Science:
- Pediatric Gastroenterology
- Neonatal Immunology
- Gastrointestinal Inflammation
Background:
- Rectal bleeding in infancy (RBI) is a common but not fully understood condition.
- Investigating the clinical course and pathogenesis of RBI is crucial for infant health.
Purpose of the Study:
- To examine the clinical course and inflammatory mechanisms of RBI, particularly in cases of food-protein-induced proctocolitis (FPIP) and neonatal transient eosinophilic colitis (NTEC).
Main Methods:
- Enrolled 22 neonates with RBI associated with FPIP and NTEC.
- Analyzed clinical data, peripheral blood counts, colonoscopy findings, and gene expression (IL-6, CCL11, CXCL13).
- Assessed outcomes including milk allergy development up to one year of age.
Main Results:
- FPIP and NTEC presented with distinct feeding-related patterns but shared inflammatory markers.
- Elevated white blood cell and eosinophil counts were observed in both groups.
- Colonoscopy revealed similar inflammatory changes, with enhanced expression of IL-6, CCL11, and CXCL13, notably CXCL13 in FPIP.
- Mucosal infiltration by CD3+ and IgA+ cells was confirmed, but not IgE+ cells.
Conclusions:
- Food-protein-induced proctocolitis (FPIP) and neonatal transient eosinophilic colitis (NTEC) are clinically similar conditions.
- Interleukin-6, CCL11, and CXCL13 are implicated in the pathogenesis of rectal bleeding in infancy.
- While allergic reactions are possible, milk allergy is not a frequent outcome in these infants within the first year.
Background:
Although rectal bleeding in infancy (RBI) is not a rare phenomenon, the clinical course of RBI is not fully understood.
Methods:
To investigate the outcome and pathogenesis of RBI, especially when concomitant with food-protein-induced proctocolitis (FPIP) and neonatal transient eosinophilic colitis (NTEC), 22 neonates with rectal bleeding with FPIP and NTEC from January 2008 to June 2012 were enrolled and their clinical course and mechanisms of inflammation were examined.
Results:
Thirteen infants showed rectal bleeding after feeding and were diagnosed with FPIP, and nine infants showed rectal bleeding before feeding and were diagnosed with NTEC. Elevated peripheral white blood cell (12,685 ± 3754/μl and 30,978 ± 16,166/μl) and eosinophil (1084 ± 816/μl and 4456 ± 3341/μl) were confirmed in FPIP and NTEC, respectively. Colonoscopy revealed nodular lymphoid hyperplasia, a pale mucosal surface and oozing with diffuse infiltration of neutrophils, lymphocytes, and eosinophils in both groups. Reverse transcription polymerase chain reaction analysis revealed enhanced expression of the interleukin-6, CCL11, and CXCL13 genes, where CXCL13 expression was more prominent in FPIP. Mucosal infiltration by CD3- and immunoglobulin-A- but not immunoglobulin-E-positive cells was confirmed. Among them, only one infant with FPIP developed milk allergy, whereas none with NTEC had developed milk allergy at the age of 1 year.
Conclusions:
FPIP in infancy and NTEC are similar diseases and interleukin-6, CCL11, and CXCL13 may play a major role in the pathogenesis of rectal bleeding. Although the involvement of allergic reaction is possible, milk allergy was not a common outcome after 1 year of follow up.
Related Concept Videos
01:25Assessment of the Rectum and Anus
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
01:27Assessing Body Temperature - Rectal
Follow these steps for rectal temperature assessment:
Step 1: Perform hand hygiene and don clean gloves to prevent cross-infection.
Step 2: Position the patient in a side-lying position to better visualize the rectal...