Document Detail


Prevalence and outcome of allergic colitis in healthy infants with rectal bleeding: a prospective cohort study.
MedLine Citation:
PMID:  15990624     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Allergic colitis is often diagnosed clinically in healthy infants with rectal bleeding and often treated with costly hypoallergenic formula. The true prevalence of allergic colitis is unknown. We tested the hypothesis that allergic colitis is overdiagnosed in healthy infants with rectal bleeding. The authors also determined whether rectal bleeding in infants without allergic colitis would resolve without diet change. METHODS: For the purposes of this study, allergic colitis was defined histologically as colonic mucosa with >or= 6 eosinophils per high power field and/or eosinophils in colonic crypts or muscularis mucosae. We surveyed all 56 Ohio NASPGHAN members to determine standard practice regarding the evaluation of rectal bleeding in infants. In addition, infants <or= 6 months old with rectal bleeding were recruited from the referral area of Cincinnati Children's Hospital Medical Center. All infants underwent flexible sigmoidoscopy with biopsies at 5, 10 and 15 cm. Formula or maternal diet was changed only for infants with histologic findings of allergic colitis as defined. Study subjects were followed for 9 weeks. RESULTS: In the survey of NASPGHAN members, 84% indicated they would empirically change the diet of an infant with rectal bleeding to treat presumed allergic colitis. In our study population, however, only 14 of 22 (64%; 95% confidence interval, 41-83) infants with rectal bleeding had allergic colitis. Five (23%) had normal biopsies and three (14%) had nonspecific colitis. Rectal bleeding in all infants with normal biopsies or nonspecific colitis resolved without diet change except for 1 infant subsequently diagnosed with infantile inflammatory bowel disease. CONCLUSION: A significant proportion of infants with rectal bleeding may not have allergic colitis and may undergo unnecessary, expensive formula or maternal diet changes that may discourage breast-feeding.
Authors:
Stavra A Xanthakos; Jeffrey B Schwimmer; Hector Melin-Aldana; Marc E Rothenberg; David P Witte; Mitchell B Cohen
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of pediatric gastroenterology and nutrition     Volume:  41     ISSN:  0277-2116     ISO Abbreviation:  J. Pediatr. Gastroenterol. Nutr.     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-07-01     Completed Date:  2005-11-10     Revised Date:  2008-09-03    
Medline Journal Info:
Nlm Unique ID:  8211545     Medline TA:  J Pediatr Gastroenterol Nutr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  16-22     Citation Subset:  IM    
Affiliation:
Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Ohio 45229-3039, USA.
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MeSH Terms
Descriptor/Qualifier:
Cohort Studies
Colitis / diet therapy*,  epidemiology*,  etiology,  pathology
Eosinophils
Female
Food Hypersensitivity / complications*,  diet therapy,  epidemiology*,  pathology
Gastrointestinal Hemorrhage / diet therapy,  epidemiology,  etiology*
Humans
Infant
Infant Formula* / economics
Infant, Newborn
Intestinal Mucosa / pathology
Male
Milk, Human / immunology
Ohio / epidemiology
Prevalence
Prospective Studies
Questionnaires
Rectum / pathology
Sigmoidoscopy
Treatment Outcome
Grant Support
ID/Acronym/Agency:
M01 RR 08084/RR/NCRR NIH HHS; R24 BK 064403/BK/FDA HHS; T32 DK07727/DK/NIDDK NIH HHS; T32 ES10957/ES/NIEHS NIH HHS
Comments/Corrections
Comment In:
J Pediatr Gastroenterol Nutr. 2005 Jul;41(1):14-5   [PMID:  15990623 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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