Food protein induced proctocolitis in neonates and infants: Clinical endoscopic histopathological findings and treatment Original Article

Öz

Aim: Allergic proctocolitis is a major cause of rectal bleeding in infants but it’s clinical features and laboratory results are often nonspecific The aim of this study was to present clinical and diagnostic features in infants with food protein induced proctocolitis Material and Method: Data of 18 infants with food protein induced proctocolitis who had received colonoscopy and biopsy were analyzed considering clinical and laboratory findings endoscopical and histopathological features and response to treatment Results: The mean age at the onset of symptoms was 8 9 weeks range 4 20 weeks Infants were admitted with apparent rectal bleeding 11 or blood streaked dappled stool 89 Feeding at onset of bleeding was exclusively breastfed 83 or formula fed 17 Laboratory findings were nonspecific Endoscopic abnormalities were observed in all patients and in 67 lenfonodular hyperplasias and in 50 erosions were determined Histopathological findings were eosinophils in lamina propria of 20 60 cells 10 high power fields in 78 and of lt;60 cells 10 high power fields in 22 Resolution of visible rectal bleeding was observed within 48 to 96 hours after elimination of the allergical proteins cow’s milk and or cow’s milk plus egg from the mother s diet or starting to feed with elementary formula Conclusions: Our study shows that proctocolitis occurs frequently in exclusively breastfed infants It is speculated that allergy to cow s milk protein may play a role in the pathogenesis In the majority of patients with food protein induced proctocolitis lenfonodular hyperplasias and erosions may be disease specific endoscopic findings Usually histologicial diagnosis is compatible with eosinophils in the lamina propria of gt;60 cells 10 high power fields Turk Arch Ped 2009; 44: 89 93 Key words: Cow’s milk allergy food protein induced proctocolitis infant rectal bleeding

Anahtar Kelimeler

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Yenidoğan ve süt çocukluğu döneminde besin proteini ilişkili proktokolit: Klinik endoskopik histopatolojik bulgular ve tedavi Orijinal Araştırma

Öz

Amaç: Alerjik proktokolit bebeklerdeki rektal kanamanın en sık nedenidir fakat klinik ve laboratuvar bulguları genellikle özgül değildir Bu çalışmanın amacı besin proteini ilişkili proktokolit tanısı alan bebeklerin klinik ve laboratuvar özelliklerini sunmaktır Gereç ve Yöntem: Kolonoskopi ve biyopsi yapılan besin proteini ilişkili proktokolitli 18 bebeğin klinik ve laboratuvar bulguları endoskopik ve histopatolojik özellikleri ile tedaviye yanıtlarını içeren verileri incelendi Bulgular: Bulgular başladığında ortalama yaş 8 9 hafta 4 20 hafta idi Bebekler belirgin rektal kanama 11 veya çizgilenme veya nokta şeklinde kanlı kaka 89 ile başvurdu Kanama başladığındaki beslenme şekli sedece anne sütü 83 veya mama 17 şeklindeydi Laboratuvar bulguları özgül değildi Tüm hastalara endoskopik inceleme yapıldı ve 67’sinde lenfonodüler hiperplazi 50’sinde erozyon saptandı Histopatolojik bulgu olarak lamina propriyada 10 büyük büyütme alanında hastaların 78’inde 60 ve üzerinde 22’sinde 20 60 arası eozinofil tespit edildi Annenin diyetinden alerjik proteininin çıkarılmasından inek sütü ve veya inek sütü ile yumurta veya elementer mama başlanmasından sonra rektal kanamanın 48 96 saat içinde iyileştiği gözlendi Çıkarımlar: Çalışmamız proktokolitin sıklıkla sadece anne sütü alan bebeklerde ortaya çıktığını göstermiştir İnek sütü proteininin patojenezde rol oynayabileceği düşünülmektedir Besin proteini ilişkili proktkolitli hastaların büyük bölümünde saptanan lenfonodüler hiperplazi ve erozyon hastalığın özgül endoskopik bulgusu olabilir Genellikle histolojik tanı lamina propriyada 10 büyük büyütme alanında 60 ve üzerinde eozinofil saptanması ile uyumludur Türk Ped Arş 2009; 44: 89 93 Anahtar kelimeler: Besin proteini ilişkili proktokolit inek sütü alerjisi rektal kanama süt çocuğu

Anahtar Kelimeler

• Besin proteini ilişkili proktokolit, inek sütü alerjisi, rektal kanama, süt çocuğu

Kaynakça

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