Allergic proctocolitis causing hematochezia in preterm twins

Allergic colitis due to cow’s milk or soy protein in commercially prepared infant formula or due to ingestion of breast-milk of mothers who are ingesting cow’s milk is a known cause of colitis occurring in infants. Allergic colitis can occur within days, weeks or months of birth and should be considered as a differential diagnosis in any infant presenting with hematochezia. Typically, there is a significant delay in the onset of milk allergy in premature infants compared to full term infants. We report a case of premature twin neonates who presented with profuse rectal bleeding during second week of life. The infants had been feeding expressed breast milk since birth and the nursing mother had been drinking cow’s milk. The infants had pneumatosis coli suggestive of inflammation of the colon while biochemical and hematological markers of inflammation were normal. Expressed breast milk was re-introduced after eliminating dairy from mother’s diet for 5 days. The infants were fed on mother’s milk and top up of hydrolyzed infant formula as required. Both the twins remained well.

Ulcerative Colitis in a Bangladeshi Child: A Case Report

Introduction: Ulcerative colitis (UC) is a chronic idiopathic inflammatory disorder of colon. Ulcerative colitis is uncommon in tropics and sub-tropics. We describe a case of pediatric ulcerative colitis with successful treatment. A 4-years-old girl who presented with passage of loose bloody stool, abdominal pain and mild arthralgia along with significant weight loss. Her height was 95 cm, and weight was 13 kg. Diagnosis was confirmed by colonoscopy and histopathology. Treatment was thereafter started with parenteral steroid initially then oral steroid and mesalamine. The patient is now on remission and is on regular follow up. UC is rare in Bangladesh, especially in children. Several conditions like infective colitis, allergic colitis, Meckel’s diverticulitis, Crohn’s disease, etc. may mimic the features of UC. So, if a child presents with recurrent bloody diarrhea, UC should be considered as a differential diagnosis. Birdem Med J 2019; 9(1): 89-94

A New Hydrolyzed Formula is Well Tolerated in Infants with Suspected Food Protein Allergy or Intolerance

Background: Extensively hydrolyzed formulas (eHF) are indicated for infants with food protein allergy. The purpose of the study was to assess the tolerance and compliance of an intended population of infants to a new formulation of a hypoallergenic eHF. Methods: A non-random, single-group, multicenter study was conducted. Infants with suspected food protein allergy, persistent feeding intolerance, or presenting conditions where an eHF was deemed appropriate were enrolled in a 15-day feeding trial. Intake, stool patterns, weight (wt), length, and questionnaires were collected. The primary outcome was maintenance of wt for age Z-score during the study. Results: 25 infants (85 ± 8.9 d of age) were enrolled; 7 were ≥ 4 months; 4 were preterm. At entry, 12 had symptoms of allergic colitis or food protein allergy/intolerance, 12 had persistent formula intolerance, 11 had hematochezia/heme positive stools, and 1 was recovering from necrotizing enterocolitis. Mean wt for age Z-score was -0.62 ± 0.19 at entry and -0.41 ± 0.16 at exit. Mean change in wt for age Z-score was 0.21 ± 0.10. Mean formula intake was 764 ± 48 mL/day. The mean number of stools/day was 1.8 ± 0.4 and the predominant stool consistencies were loose/mushy (48%) or soft (43%). Conclusion: The results suggest that this eHF was well accepted and tolerated by an intended use population of infants during the first 6 months of life which enabled adequate volume consumption, maintenance of wt for age Z-scores and a high level of parental satisfaction.

Allergic proctocolitis: the clinical evolution of a transitory disease with a familial trend. Case reports

Allergic colitis is a clinical manifestation of food allergy during the first months of life. It is estimated that genetic factors play a role in the expression of this allergic disease. This case report described the clinical progress of infants who were cousins from two distinct family groups with allergic colitis. Five infants under six months of age and of both sexes were studied, with a diagnosis of allergic colitis characterized clinically and histologically by (1) rectal bleeding; (2) exclusion of infectious causes of colitis; (3) disappearance of symptoms after elimination of cow's milk and dairy products from the child's and/or the mother's diet. Patients were submitted to the following diagnostic investigation: complete blood count; stool culture; parasitologic examination of stools; rectoscopy or colonoscopy; and rectal biopsy. Patient age varied from 40 days to six months; three were males. All patients presented with complaints of intense colic and rectal bleeding. The colonoscopy showed presence of hyperemia of the mucosa with microerosions and spontaneous bleeding upon the procedure. Microscopy revealed the existence of colitis with eosinophilia >20 e/HPF. Patients were treated with a hypoallergenic formula and showed remission of symptoms. After one year of age, all were submitted to an oral challenge with a milk formula and presented food tolerance. Allergic colitis is a disease with evident genetic inheritance and a temporary character.