E. Mahir GÜLCAN, Coşkun SAF, Nil ÇOMUNOĞLU, Selami SÖZÜBİR, Reha CENGİZLİER, Ayça VİTRİNEL

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

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

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

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

Keywords:

-,

PDF

___

Özkan T, Erdemir G. Besin alerjileri. Güncel Pediatri 2006; 3: 75-98. (Full Text) / (PDF)
Chehade M. IgE and non-IgE-mediated food allergy: treatment in 2007. Curr Opin Allergy Clin Immunol 2007; 73: 264-8. (Abstract)
Kırsaçlıoğlu CT, Özden A. Besin alerjileri. Güncel Gastroenteroloji 2006; 10: 148-59. (PDF)
Arvola T, Ruuska T, Keranen J, Hyöth H, Salminen S, Isolauri E. Rectal bleeding in infancy: clinical, allergological, and microbi- ological examination. Pediatrics 2006; 117: 760-8. (Abstract) / (Full Text) / (PDF)
Hwang JB, Park MH, Kang YN, Kim SP, Suh SI, Kam S. Adven- ced criteria for clinicopathological diagnosis of food protein-in- duced proctocolitis. J Korean Med Sci 2007; 22: 213-7. (Abstract) (Full Text) / (PDF)
Eigenmann PA. Mechanisms of food allergy. Pediatr Allergy Im- munol 2009; 20: 5-11. (Abstract) / (Full Text) / (PDF)
Bone J, Claver A, Guallar I, Plaza AM. Allergic proctocolitis, fo- od-induced enterocolitis: immune mechanisms, diagnosis and treatment. Allergol Immunupathol 2009; 37: 36-42. (Abstract)
Heine RG. Pathophysiology, diagnosis and treatment of food protein-induced gastrointestinal diseases. Curr Opin Allergy 2004; 4: 221-9.(Abstract)
Lake AM. Food-induced eosinophilic proctocolitis. J Pediatr Gastroenterol Nutr 2000; 30: 58-60. (Abstract)
Hirose R, Yamada T, Hayashida Y. Massive bloody stools in two ne- onates caused cow’s milk allergy. Pediatr Surg Int 2006; 22: 935-8. (Abstract) / (Full Text) / (PDF)
Troncone R, Discepolo V. Colon in food allergy. J Pediatr Gas- troenterol Nutr 2009; 49: 89-91.(Abstract) / (PDF)
Xanthakos S, Schimmer JB, Aldana HM, Rothenberg ME, Witte DP, Cohen MB. Prevalence and outcome of allergic colitis in he- althy infants with rectal bleeding: a prospective cohort study. J Pediatr Gastroenterol Nutr 2005; 41: 16-22. (Abstract) / (PDF)
Maloney J, Wegrzyn AN. Educational clinical case series for pe- diatric allergy and immunology: allergic proctocolitis, food pro- tein-induced enterocolitis syndrome and allergic eosinophilic gastroenteritis with protein losing gastroenteropathy as mani- festations of non-IgE-mediated cow’s milk allergy. Pediatr Al- lergy Immunol 2007; 18: 360-7. (Abstract)
Lake A. Infantile proctocolitis: are we empirically too casual? J Pediatr Gastroenterol Nutr 2005; 41: 14-5. (Abstract) / (PDF)
Pumperger W, Pomberger G, Geissler W. Proctocolitis in breastfed infants: a contribution to differential diagnosis of ha- ematochezia in early childhood. Postgrad Med J 2001; 77: 252-4. (Abstract) / (Full Text) / (PDF)
Gottrand F, Erkan T, Fabriaux JP, et al. Food-induced bleeding from lymphonodular hyperplasia of colon. Am J Dis Child 1993; 147: 821-3. (Abstract)
Winter HS, Antonioli DA, Fukagawa N, et al. Allergy-related proctocolitis in infants: diagnostic usefulness of rectal biopsy. Mod Pathol 1990; 3: 5-10. (Abstract)
Kokkonen J, Karttunen TJ. Lymphonodular hyperplasia on the mucosa of the lower gastrointestinal tract in children: an indica- tion of enhanced immune response? J Pediatr Gastroenterol Nutr 2002; 34: 42-6. (Abstract)
Odze RD, Bines J, Leichtner AM, GoldmanH, Antonioli DA. Al- lergic proctocolitis in infants: a prospective clinicopathologic bi- opsy study. Hum Pathol 1993; 24: 668-74. (Abstract)
Odze RD, Wershil BK, Leichtner AM, Antonioli DA. Allergic coli- tis in infants. J Pediatr 1995; 126: 163-70. (Full Text) / (PDF)
Machida HM, Catto-Smith AG, Gall DG, Trevenen C, Scott RB. Allergic colitis in infancy: clinical and pathologic aspects. J Pe- diatr Gastroenterol Nutr 1994: 19: 22-6. (Abstract) / (PDF)