Neonatal Transient Eosinophilic Colitis Causes Lower Gastrointestinal Bleeding in Early Infancy

Ohtsuka, Yoshikazu; Shimizu, Toshiaki; Shoji, Hiromichi; Kudo, Toshifumi; Fujii, Tohru; Wada, Mariko; Sato, Hiroaki; Aoyagi, Yo; Haruna, Hidenori; Nagata, Satoru; Yamashiro, Yuichiro

doi:10.1097/01.mpg.0000252194.06955.18

Cited by 51 publications

(39 citation statements)

References 8 publications

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“…For instance, infants with neonatal transient eosinophilic colitis exhibit LGB before milk ingestion. 3 Some infants with LGB exhibit oligoclonal antigen-specific reactions against food proteins, even though they have not been exposed to food antigens except through breast milk in early infancy. 4,5 It is thought that these infants are sensitized in utero.…”

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confidence: 99%

Microarray analysis of mucosal biopsy specimens in neonates with rectal bleeding: Is it really an allergic disease?

Ohtsuka¹,

Jimbo²,

Inage³

et al. 2012

Journal of Allergy and Clinical Immunology

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confidence: 99%

Microarray analysis of mucosal biopsy specimens in neonates with rectal bleeding: Is it really an allergic disease?

Ohtsuka¹,

Jimbo²,

Inage³

et al. 2012

Journal of Allergy and Clinical Immunology

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“…A significant proportion of patients developed tolerance after 1 year of a strict elimination diet [17]. In addition, there are types of EC that do not present any allergic reactions, like neonatal transient EC [23]. Indeed, the elimination and provocation tests were negative in our cases.…”

Section: Discussionmentioning

confidence: 92%

Eosinophilic Gastrointestinal Disorders in Infants: A Japanese Case Series

Yamada

Nishi²,

Ebara³

et al. 2011

Int Arch Allergy Immunol

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Background: Eosinophilic gastrointestinal disorders (EGIDs) are disorders characterized by primary eosinophil inflammation in the gastrointestinal tract. There are a small number of reports of eosinophil infiltration in gastrointestinal tracts presenting as EGIDs in infants. In this study, we present Japanese cases of EGIDs in infants. Methods: Five patients diagnosed with or strongly suspected to have EGIDs in our hospital from 2008 to 2010 were reviewed. Radiographic contrast enema examinations and/or endoscopies were performed in 4 and 3 patients, respectively. Results: There were patients with eosinophilic colitis (1 suspected and 2 biopsy-proven), a patient who was suspected of having allergic eosinophilic enterocolitis, and a patient with eosinophilic gastroenteritis associated with pediatric hypereosinophilic syndrome. Conclusions: The causes and clinical findings of patients with intestinal eosinophil inflammation vary. Therefore, deliberate examination and observation are important for patients with infantile EGID.

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“…In older infants the combination of bloody stools and eosinophilia suggests atopic conditions involving the bowel, such as allergic enterocolitis, 11 cow's milk allergy 12 or foodinduced eosinophilic proctocolitis. 13,14 However, when bloody stools occur in a prematurely born infant cared for in a NICU, NEC must be a prime consideration, 15,16 although, as suggested by Srinivasan et al 11 , allergic enteropathy can be causative and can be difficult to distinguish from NEC. We aimed to further investigate this issue by applying a rigorous definition of eosinophilia 2 to all neonates with bloody stools identified in a multihospital database.…”

Section: Discussionmentioning

confidence: 99%

Neonates presenting with bloody stools and eosinophilia can progress to two different types of necrotizing enterocolitis

et al. 2011

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Objective: We hypothesized that neonates with bloody stools and concomitant eosinophilia are likely to have atopic enteropathy rather than necrotizing enterocolitis (NEC).Study Design: This was a retrospective cross-sectional study using electronic medical records and paper charts. Records of neonates admitted to any Intermountain Healthcare NICU between 1 January 2005 and 30 June 2010 were eligible if 'bloody stools' were listed in any archive. Qualifying records were divided into two groups depending on whether or not within 72 h of passing bloody stool eosinophil counts were above the 95th percentile reference range limit for age.Result: Bloody stools were identified in 275 predominantly Caucasian neonates. Fifty-four of these had eosinophilia and 221 had normal eosinophil counts. Those with eosinophilia were born at a slightly younger gestational age (31.3±4.6 vs 32.6±4.0 weeks, mean±s.d., P ¼ 0.032). Contrary to our hypothesis, those with eosinophilia did not have a lower rate of pneumatosis or bowel resection, or death ascribed to NEC. Eosinophilia was more common among those who had a red blood cell (RBC) transfusion within 48 h before passing bloody stools (P<0.001). Those with a recent RBC transfusion were the only neonates to have NEC surgery or to die from NEC. Preceding the bloody stools, those with no antecedent transfusion had been fed a larger volume (P ¼ 0.014), and had trends toward receiving calorically enriched feedings (P ¼ 0.055) and recent addition of human milk fortifier (P ¼ 0.060). Eosinophil counts following RBC transfusion tended to increase for 3-6 days, but when bloody stools were not preceded by transfusion the eosinophil counts were more static over that period. Conclusion:In this predominantly Caucasian group of neonates with bloody stools, the presence of eosinophilia did not identify a benign condition distinct from NEC. A total of 44% of these neonates had transfusion-associated NEC. Eosinophils could have a previously unrecognized role in the pathogenesis of this NEC subtype. Keywords: necrotizing enterocolitis; bloody stools; eosinophilia; RBC transfusion; transfusion-associated NEC; atopic enteropathy Introduction Eosinophilia is diagnosed when the concentration of eosinophils in the blood exceeds the upper reference range limit. 1 Until recently, this upper limit was not well defined for neonates, allowing imprecision in defining eosinophilia and in identifying associations between it and various clinical conditions. Using laboratory values from over 63 000 neonates we recently reported the 5th and 95th percentile values for blood eosinophil concentrations at various gestational and postnatal ages. 2 The 95th percentile upper limit ranges from 1180 eosinophils ml À1 in the first week to about 1560 ml À1 after 3 weeks. 2 Given this more precise definition of neonatal eosinophilia, we commenced the present study of the association between bloody stools and eosinophilia.When bloody stools are observed in a neonate, the possibility of necrotizing enterocolitis (NEC) enters the ...

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Neonatal Transient Eosinophilic Colitis Causes Lower Gastrointestinal Bleeding in Early Infancy

Abstract: Inasmuch as these infants had LGB similar to allergic proctocolitis without any allergic reactions, we suggest that infiltrated eosinophils in the colonic mucosa could be involved in the pathogenesis of LGB in early infancy.

Cited by 51 publications

References 8 publications

Microarray analysis of mucosal biopsy specimens in neonates with rectal bleeding: Is it really an allergic disease?

Microarray analysis of mucosal biopsy specimens in neonates with rectal bleeding: Is it really an allergic disease?

Eosinophilic Gastrointestinal Disorders in Infants: A Japanese Case Series

Neonates presenting with bloody stools and eosinophilia can progress to two different types of necrotizing enterocolitis

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