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Allergic proctocolitis in infants: a prospective clinicopathologic biopsy study
R D Odze1, J Bines, A M Leichtner
1Department of Pathology, Children's Beth Israel Hospital, Boston, MA.
Human Pathology
|June 1, 1993
Summary
Eosinophils are a key indicator for diagnosing allergic proctocolitis in infants presenting with rectal bleeding. Obtaining multiple biopsy samples is crucial due to the focal distribution of these inflammatory cells.
Area of Science:
- Gastroenterology
- Pediatric Pathology
- Immunology
Background:
- Allergic proctocolitis is a common cause of infant rectal bleeding, often with non-specific clinical signs.
- Previous research indicated a strong association between high colonic eosinophil counts and allergic proctocolitis.
Purpose of the Study:
- To prospectively validate eosinophils as a diagnostic marker for allergic proctocolitis in infants.
- To characterize the distribution of eosinophils in colonic biopsies.
- To correlate eosinophil findings with clinical data.
Main Methods:
- Prospective analysis of 60 colonic mucosal biopsy specimens from 20 infants with confirmed allergic proctocolitis.
- Biopsies were taken from standardized sites (4, 8, and 12 cm from the anal verge).
- Histologic examination focused on eosinophil counts and distribution, correlated with clinical and endoscopic findings.
Main Results:
- A significant focal increase in eosinophils was observed in all mucosal compartments, often near lymphoid nodules.
- Eosinophilic infiltration showed focal distribution, with only 60% of patients having all three biopsy sites abnormal.
- No significant correlation was found between eosinophil counts and patient age, illness duration, endoscopic appearance, or formula type.
Conclusions:
- Eosinophils are a reliable diagnostic marker for infantile allergic proctocolitis.
- The focal nature of eosinophilic infiltration necessitates multiple biopsy specimens and examination of several tissue levels for accurate diagnosis.