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Proctocolitis in exclusively breast-fed infants
L Anveden-Hertzberg1, Y Finkel, B Sandstedt
1Department of Paediatric Surgery, St. Göran's Hospital, Stockholm, Sweden.
Insights
Mild rectal bleeding in exclusively breast-fed infants may be caused by cow's milk protein allergy. Dietary changes in mothers breastfeeding their infants can resolve proctocolitis symptoms.
Area of Science:
- Pediatrics
- Gastroenterology
- Allergy & Immunology
Background:
- Proctocolitis, characterized by rectal bleeding, can occur in exclusively breast-fed infants.
- The etiology of proctocolitis in this population is not fully understood.
Purpose of the Study:
- To investigate the potential role of cow's milk protein allergy in exclusively breast-fed infants presenting with proctocolitis.
- To evaluate the efficacy of maternal dietary restriction of cow's milk protein.
Main Methods:
- Rectosigmoidoscopy and rectal mucosal biopsy were performed in nine exclusively breast-fed infants with rectal bleeding.
- Histological examination revealed eosinophilic infiltration in rectal biopsies.
- Maternal intake of cow's milk protein was restricted in seven mothers.
Main Results:
- Rectosigmoidoscopy showed inflammatory changes, including oedematous mucosa and petechial haemorrhages.
- Rectal biopsies revealed intra-epithelial eosinophilic granulocytes and lamina propria eosinophilia.
- Six out of seven infants whose mothers restricted cow's milk protein intake showed symptom resolution within 4 weeks.
Conclusions:
- Cow's milk protein allergy transferred via breast milk is a potential cause of proctocolitis in exclusively breast-fed infants.
- Maternal dietary restriction of cow's milk protein appears to be an effective treatment for this condition.
Unlabelled:
We present nine exclusively breast-fed, full-term infants with mild rectal bleeding due to proctocolitis. The mean age at the onset of symptoms was 5 weeks (range 1-8 weeks). Rectosigmoidoscopic examination was performed in all the children within 2 days after admission, showing inflammatory changes such as oedematous mucosa with petechial haemorrhages. Rectal mucosal biopsy specimens were obtained in eight cases and revealed intra-epithelial eosinophilic granulocytes in seven and a diffuse increase of eosinophils in the lamina propria in six. Allergy to cow's milk protein transferred to the infants via the breast milk was believed to be the cause of the inflammation. The intake of cow's milk protein was then restricted in seven mothers. Following this regimen, symptoms were relieved within 4 weeks in the six infants who were seen at follow up. One child recovered spontaneously without dietary restrictions. Considering the beneficial effect of the diet regimen in addition to the histological findings, allergy to cow's milk protein is possibly the aetiology of the proctocolitis seen in these nine exclusively breast-fed babies, although no challenge tests were performed to confirm this suspicion.
Conclusion:
This report shows that proctocolitis occurs in exclusively breast-fed infants. It is speculated that allergy to cow's milk protein may have played a role in the pathogenesis.