Clinical characteristics of allergic colitis and the expression of eosinophil cationic protein in intestinal mucosa in infants / 临床儿科杂志

Objectives To explore the clinical features of allergic colitis and the expression of eosinophil cationic protein (ECP) in intestinal mucosa in infant and young children. Methods The clinical data of 24 cases of allergic colitis treated from September 2011 to February 2014 were analyzed retrospectively. Immunohistochemical staining was used to detect expressions of ECP in intestinal mucosa in 24 cases of allergic colitis, gastric and duodenal mucosa in 16 cases of helicobacter pylori infection and proximal normal intestinal mucosa in 18 cases of postoperative resection of congenital megacolon, and the results were compared. Results In the 24 subjects (15 males and 8 females) with allergic colitis,. they were infants except for 1 subject, and 20 subjects were <6 months old. All of them had bloody stool, in which there were 15 cases of diarrhea, 1 case of eczema and 3 cases of drug allergy. The endoscopic lesions were mainly showed in the sigmoid colon (12 cases) and the rectum (11 cases). The most common manifestations were mucosal erythema (21 cases), pox like nodules (18 cases), erosions (3 cases), and ulcers (3 cases). Histopathological findings were eosinophilic infiltration of the mucosa. The number of eosinophils in intestinal mucosa was 42(30~60)in patients with allergic colitis whose ECP was positive,18(15~23)in patients with Helicobacter pylori infection and 25.5 (14~35) in patients with congenital megacolon children, and the differences are statistically significant mong three groups (H=28.14,P<0.001). Conclusions Allergic colitis is more common in infants and young children. The main endoscopic findings are mucosal erythema and eruption like nodules. In addition, the increase of ECP positive eosinophils in intestinal mucosa is the characteristic manifestation of allergic colitis.

Clinical characteristics of allergic colitis and the expression of eosinophil cationic protein in intestinal mucosa in infants / 临床儿科杂志

Objectives To explore the clinical features of allergic colitis and the expression of eosinophil cationic protein (ECP) in intestinal mucosa in infant and young children. Methods The clinical data of 24 cases of allergic colitis treated from September 2011 to February 2014 were analyzed retrospectively. Immunohistochemical staining was used to detect expressions of ECP in intestinal mucosa in 24 cases of allergic colitis, gastric and duodenal mucosa in 16 cases of helicobacter pylori infection and proximal normal intestinal mucosa in 18 cases of postoperative resection of congenital megacolon, and the results were compared. Results In the 24 subjects (15 males and 8 females) with allergic colitis,. they were infants except for 1 subject, and 20 subjects were <6 months old. All of them had bloody stool, in which there were 15 cases of diarrhea, 1 case of eczema and 3 cases of drug allergy. The endoscopic lesions were mainly showed in the sigmoid colon (12 cases) and the rectum (11 cases). The most common manifestations were mucosal erythema (21 cases), pox like nodules (18 cases), erosions (3 cases), and ulcers (3 cases). Histopathological findings were eosinophilic infiltration of the mucosa. The number of eosinophils in intestinal mucosa was 42(30~60)in patients with allergic colitis whose ECP was positive,18(15~23)in patients with Helicobacter pylori infection and 25.5 (14~35) in patients with congenital megacolon children, and the differences are statistically significant mong three groups (H=28.14,P<0.001). Conclusions Allergic colitis is more common in infants and young children. The main endoscopic findings are mucosal erythema and eruption like nodules. In addition, the increase of ECP positive eosinophils in intestinal mucosa is the characteristic manifestation of allergic colitis.

Deposiciones sanguinolentas iniciadas en los primeros días de vida / Bloody stools started in the first days of life

La proctocolitis alérgica del lactante es un trastorno caracterizado por la presencia de deposiciones mucosanguinolentas en los dos primeros meses de vida, pudiendo aparecer en los primeros días de vida. Anteriormente, relacionado con niños alimentados con lactancia artificial, en los últimos años se observa un aumento de la incidencia en niños alimentados con lactancia materna exclusiva debido al paso de proteínas de leche de vaca a la leche de la madre. Recién nacido a término, alimentado con lactancia materna exclusiva inicia a los dos días de vida deposiciones con hebras de sangre de forma intermitente. Todos los estudios realizados resultan normales. La clínica mejora progresivamente tras la eliminación de las proteínas de leche de vaca de la dieta de la madre, por lo que se diagnostica de proctocolitis alérgica. El diagnóstico se basa en la clínica, la desaparición de los síntomas al retirar las proteínas de leche de vaca de la dieta, y en la reaparición de éstos al reintroducirla. Los niños mantienen buen estado general en todo momento, siendo la gran mayoría tolerantes a la leche de vaca al año de vida, por lo que se considera una patología de buen pronóstico.

Allergic colitis is a pathology characterized by blood in faeces, appeared in first two months of life, but it can also appear during the first days of life. Previously it was related with children with non breastfeeding, however in the last years incidence is increasing in children with breastfeeding. This is explained with the presence of cow’s milk proteins in human’s milk. Newborn term, fed with exclusive breastfeeding, starts at second day of life blood in faeces, intermittently. The studies done are normal. The symptoms improve progressively after removing the cow’s milk proteins of the mother’s diet, so the child is diagnosed with allergic protocolitis. Diagnosis is based on the symptoms, the improvement with the removal of the cow’s milk protein of the diet, and the worsening when they are reintroduced. The children conserve good general condition every moment, almost all of them tolerate cow’s milk when they are one year old, and so it is considered pathology of well prognosis.

The value of narrow-band imaging for targeting biopsy of lesions in children with allergic colitis / 中华消化内镜杂志

Objective To evaluate the value of endoscopy with narrow-band imaging(NBI)for tar-geting biopsy of lesions in children with allergic colitis. Methods The colorectal lesions under the model of traditional white light imaging and NBI in children with allergic colitis were observed and recorded. The re-sults of biopsy under white light imaging and NBI were compared with postoperative pathological diagnosis. Results A total of 60 patients completed the study. Under NBI,47(78. 3%)rectal lesions,52(86. 7%) sigmoid colon lesions and 19(31. 7%)descending colon lesions were found. There were 21(35. 0%),25 (41. 7%),and 8(13. 3%)lesions in the transverse colon,ascending colon and iloececus,respectively. For the lesions in transverse colon and ascending colon,the detection rate under NBI was significantly higher than that under white light endoscopy[35. 0% VS 16. 7%(10/ 60),P0. 05;78. 3% VS 76. 7%(46/ 60),P>0. 05].There was no significant difference in ileo-cecus and descending colon[13. 3% VS 5. 0%(3/ 60),P>0. 05;31. 7% VS 28. 3%(17/ 60),P>0. 05]. The targeted biopsy results by NBI indicated that the ratio of EOS≥6/ HP was significantly higher than the biopsy results by white light imaging. Conclusion NBI is easy to operate and can discern the microcosmic structure which cannot be observed by the traditional endoscopy. It can provide higher diagnostic accuracy of allergic colitis. After suspicious lesions were found under conventional endoscopic check,NBI could be used to guide the targeted biopsy.

A Clinical and Histological Study of Allergic Colitis in Infant

PURPOSE: This study was done to evaluate the clinical and pathologic aspects of allergic colitis. METHODS: This study evaluated 19 infants who presented with fresh blood mixed stools. Limited colonoscopy and biopsy were performed. Among the 19 infants, 13 infants were diagnosed as allergic colitis by histological findings. We analyzed the clinical and histological characteristics of 13 infants. RESULTS: Male and female were 8 and 5 respectively. The mean age of the infants was 3 months (4 days to 12 months). Major symptoms were rectal bleeding (13), mucoid stool (6), diarrhea (5), vomiting (2). Feedings before diagnosis were breast milk (3), formula milk (4), formula and breast milk (5), and weaning diet (1). In labortory data, anemia (2) and eosinophilia (12) were found in some infants. Endoscopic findings were focal erythema (7), nodularity (1), erythema and nodularity (4), hemorrhage (1). Histopathologic finding was eosinophilic infiltration in lamina propria with preserved mucosal architecture in all. In addition, cryptitis (13), lymphoid follicular hyperplasia (7), crypt abscess (1) were also observed. All the infants improved with cessation of rectal bleeding and diarrhea within three days after dietary change. CONCLUSION: Allergic colitis should be considered as one of the major cause of rectal bleeding in healthy appearing infants. Limited colonoscopy and biopsy should be considered in establishing a definitive diagnosis.