Gastrointestinal Occult Hemorrhage and Gastroduodenitis in Cowʼs Milk Protein Intolerance

The development of safe fiberoptic endoscopy in neonates led to the identification of the occurrence of severe esophageal and gastric lesions (EGL) in the first days of life. The cause of these early acute lesions, which are associated most of the time with severe clinical symptoms, remains unknown. 34 neonates with EGL were compared with controls born in the same maternity unit immediately after those enrolled in the EGL series. Clinical and obstetric data were not different in the 2 groups. Breast-feeding was less frequent (p < 0.01) and given later (p = 0.0001) in babies with EGL. This retrospective analysis yielded no indication relative to the causative phenomenon leading to such mucosal alterations. In contrast, it provides the first evidence of a possible protective role of breast-feeding.

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“…A direct action of gastric acidity was previously incriminated [6,7]. Allergic or infectious processes were incriminated but not confirmed [8,9].…”

Section: Discussionmentioning

confidence: 99%

Possible Protection by Breast-Feeding against Severe Esophageal and Gastric Lesions in the Neonate

Benhamou

Cheikh²,

Francoual³

et al. 1998

Neonatology

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“…FPIES is classified as a cellmediated disorder presumed to involve antigen-specific T lymphocytes, monocytes, antibodies, and cytokines as a cause of inflammation in the colon and, with variable degrees, the ileum [70,[91][92][93][94][95][96][97]. This inflammation is hypothesized to result in increased intestinal permeability leading to a fluid shift into the gastrointestinal lumen.…”

Section: Pathophysiologymentioning

confidence: 99%

Food Protein–Induced Enterocolitis Syndrome

Nowak‐Węgrzyn

Jarocka-Cyrta

Castro

2017

J Investig Allergol Clin Immunol

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Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-, cell-mediated food allergy of unknown prevalence and pathophysiology. Onset is typically during the first year of life; seafood-induced FPIES may start in adulthood. Acute FPIES manifests within 1-4 hours after ingestion with repetitive emesis, pallor, and lethargy progressing to dehydration and hypovolemic shock in 15% of cases. Chronic FPIES manifests with intermittent emesis, watery diarrhea, and poor growth progressing to dehydration and hypovolemic shock over a period of days to weeks. Chronic FPIES has been only reported in infants aged less than 3 months fed with cow milk (CM) or soy formula. The most common triggers are CM, soy, rice, and oat. Diagnosis of FPIES relies on recognition of a pattern of clinical symptoms and may be missed owing to the absence of typical allergic symptoms (eg, urticaria, wheezing) and delayed onset in relation to food ingestion. Physician-supervised food challenge is recommended if diagnosis or the trigger food is not clear and to evaluate for resolution. Testing for food-specific IgE is usually negative, although a subset of patients, usually with CM-induced FPIES may develop sensitization to foods. Such atypical FPIES tends to have a more prolonged course. Despite the potential severity of the reactions, no fatalities have been reported, and FPIES has a favorable prognosis. In most cases, FPIES resolves by age 3-5 years, although persistence of CM-induced FPIES and soy FPIES into adulthood has been reported. The first international consensus guidelines on diagnosis and management of FPIES were published in 2017. Given that the pathophysiology of FPIES is poorly understood, there are no diagnostic biomarkers and no therapies to accelerate resolution. These unmet needs warrant future investigations to improve the care of patients with FPIES. Key words: FPIES. Food protein-induced enterocolitis syndrome. Non-IgE-mediated food allergy. Food allergy. Cow milk allergy. ResumenSEIOA es una alergia alimentaria con patofisiología y prevalencia desconocidas, que típicamente comienza en el primer año de vida, mientras que la producida por pescado suelo tener su comienzo en adultos. La forma aguda se manifiesta entre la hora y 4 horas tras la ingesta del alimento con emesis, palidez, letargia progresiva por deshidratación y shock hipovolémico en el 15% de los casos. La forma crónica se manifiesta con emesis intermitente, diarreas y crecimiento pobre con progresión hacia la deshidratación y shock hipovolémico en un periodo de días o semanas. La forma crónica se ha podido observar únicamente en niños menores de 3 años alimentados con leche de vaca o fórmula de soja. Los desencadenantes más frecuentes son la leche de vaca, la soja, el arroz y avena. El diagnóstico es clínico y puede ser difícil debido a la ausencia de síntomas alérgicos típicos (urticaria, asma…) y a la relación retardada con la ingesta. Es recomendable la provocación controlada si el diagnóstico clínico o el alimento implicado no son claros y tamb...

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“…Mesmo nos pacientes com sintomas de gastrite iniciados de forma abrupta, foi observado retardo ponderal, sugerindo que já havia má-absorção. Todos os pacientes relatados por Coello-Ramirez e Larrosa-Haro apresentavam teste de absorção de Dxilose anormal 6 . Nossos dois pacientes apresentaram atrofia vilositária, um deles subtotal em biópsias de duodeno associada a infiltrado linfoplasmocitário, e alterações similares foram também descritas por Brunerie e col. 7 Portanto, comprometimento do intestino delgado é freqüente e justifica o agravo nutricional encontrado entre os casos relatados.…”

Section: Comentáriosunclassified

“…Ao contrá-rio da colite alérgica, em que até 40% dos pacientes apresentam eosinofilia importante, tal alteração não foi observada em nenhum dos pacientes relatados com gastrite alérgica [6][7][8][9][10]16 .…”

Section: Comentáriosunclassified

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Gastrite hemorrágica por alergia ao leite de vaca: relato de dois casos

Machado¹,

Kawakami²,

Goshima³

et al. 2003

J. Pediatr. (Rio J.)

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Artigo submetido em 17.02.03, aceito em 28.05.03. ResumoObjetivo: descrever dois lactentes com gastrite hemorrágica, devido à alergia ao leite de vaca.Descrição dos casos: ambos os pacientes apresentavam hematêmese, vômitos e desnutrição. Os pacientes apresentavam infiltrado eosinofílico em mucosa gástrica biopsiada e resolução dos sintomas após o início de dieta com exclusão da proteína do leite de vaca.Comentários: gastrite hemorrágica devido à alergia ao leite de vaca é um diagnóstico incomum. Até o momento foram relatados 10 pacientes com gastrite alérgica, e as principais manifestações clíni-cas são vômitos, desnutrição, anemia e hematêmese. A gastrite por alergia ao leite de vaca pode apresentar-se em diferentes graus de gravidade, e pode ser subdiagnosticada em muitos pacientes. A menos que o tratamento correto seja iniciado, o paciente desenvolverá desnutrição protéico-calórica grave e anemia. Doença alérgica do trato gastrointestinal superior deve ser considerada em todos os lactentes com vômitos recorrentes, particularmente se complicado com hematêmese. O diagnóstico de gastrite alérgica é clínico, auxiliado pela endoscopia e anatomia patológica.J Pediatr (Rio J) 2003;79(4):363-8: gastrite hemorrágica, alergia ao leite de vaca, lactentes. AbstractObjective: to report two cases of infants with hemorrhagic gastritis due to cow's milk allergy.Description: the clinical features included hematemesis, vomiting and malnutrition. All patients had eosinophilic infiltrate in gastric biopsies and got favorable clinical outcome after cow's milk free diet.Comments: hemorrhagic gastritis due to cow's milk allergy is an uncommon diagnosis. Clinical findings in 10 patients (including ours) reported with allergic gastritis were vomiting, malnutrition, anemia, and hematemesis. Gastritis occurs in cow's milk allergy in a wide range of severity, and it could remain hidden in most patients. Unless appropriate management is ensued, patients develop severe malnutrition and severe anemia. Allergic compromise of upper gastrointestinal tract might be considered in all vomiting infants particularly if complicated by hematemesis. Diagnosis of allergic gastritis relies on clinical suspicion helped by endoscopy and gastric biopsies. As manifestações gastrointestinais de alergia alimentar incluem diarréia crônica com má absorção, sangramento retal, refluxo gastroesofágico, constipação intestinal e hemorragia digestiva alta [1][2][3][4] . Refluxo gastroesofágico (RGE) e alergia ao leite de vaca (ALV) são considerados os distúrbios gastrointestinais mais comuns em lactentes no primeiro ano de vida, e, muitas vezes, são patologias relacionadas 3,5 . Vômitos persistentes, ganho ponderal in- J Pediatr (Rio

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Gastrointestinal Occult Hemorrhage and Gastroduodenitis in Cowʼs Milk Protein Intolerance

Cited by 46 publications

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Possible Protection by Breast-Feeding against Severe Esophageal and Gastric Lesions in the Neonate

Possible Protection by Breast-Feeding against Severe Esophageal and Gastric Lesions in the Neonate

Food Protein–Induced Enterocolitis Syndrome

Gastrite hemorrágica por alergia ao leite de vaca: relato de dois casos

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