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Allergic proctitis and gastroenteritis in children. Clinical and mucosal biopsy features in 53 cases
Insights
Pediatric allergic proctitis and gastroenteritis present differently, with proctitis responding to diet while gastroenteritis often requires corticosteroids. Diagnosis involves biopsy and symptom evaluation for effective treatment.
Area of Science:
- Pediatric Gastroenterology
- Allergology
- Immunology
Background:
- Allergic disorders of the gastrointestinal tract are increasingly recognized in children.
- Distinguishing between allergic proctitis and gastroenteritis is crucial for appropriate management.
Purpose of the Study:
- To characterize the clinical presentation, diagnostic findings, and treatment outcomes of allergic proctitis and allergic gastroenteritis in children.
- To compare the two conditions in terms of age of onset, symptoms, biopsy findings, and response to therapy.
Main Methods:
- Retrospective review of 53 pediatric cases with allergic gastrointestinal disorders.
- Analysis of clinical data, including age, symptoms, allergic history, and laboratory findings.
- Histopathological examination of mucosal biopsies from various gastrointestinal segments.
Main Results:
- Allergic proctitis (15 cases) typically presented in infants under 2 years with rectal bleeding; biopsies showed eosinophilic infiltration. Allergic gastroenteritis (38 cases) affected all ages with varied symptoms and biopsy findings across the GI tract.
- Proctitis resolved with dietary changes, while gastroenteritis cases frequently relapsed and required corticosteroids.
Conclusions:
- Allergic proctitis and gastroenteritis are distinct pediatric allergic GI conditions with different clinical courses and treatment responses.
- Dietary modification is effective for allergic proctitis, whereas allergic gastroenteritis often necessitates a more aggressive therapeutic approach including corticosteroids.
Abstract:
We have reviewed 53 cases of allergic disorders of the gastrointestinal tract in children, including 15 with principal effects in the rectum (allergic proctitis) and 38 with dominant involvement of the upper and mid portions of the gut (allergic gastroenteritis). Most cases of allergic proctitis had their onset at less than 6 months of age, and all were under 2 years old when they presented with rectal bleeding alone or in combination with diarrhea. Rectal mucosal biopsy revealed in most cases a diffuse increase of eosinophils in the lamina propria together with a focal infiltration of the epithelium by eosinophils. Cases of allergic gastroenteritis affected all age groups and had a lower frequency of overt rectal bleeding. More common were other symptoms (vomiting, pain, and weight loss), an allergic history, anemia, blood eosinophilia, and increased serum IgE. Mucosal biopsy abnormalities were present in the gastric antrum in all cases sampled, the small intestine in 79%, the esophagus in 60%, and the gastric corpus in 52%. The lesions were usually diffuse and marked in the antrum and esophagus; in contrast, they tended to be focal and mild in the small intestine and gastric corpus. All cases of proctitis responded to a dietary change by cessation of symptoms without recurrences, whereas most of those with gastroenteritis had multiple relapses and required corticosteroid therapy.