Objectives: Allergic colitis is often diagnosed clinically in healthy infants with rectal bleeding and often treated with costly hypoallergenic formula. The true prevalence of allergic colitis is unknown. We tested the hypothesis that allergic colitis is overdiagnosed in healthy infants with rectal bleeding. The authors also determined whether rectal bleeding in infants without allergic colitis would resolve without diet change.
Methods: For the purposes of this study, allergic colitis was defined histologically as colonic mucosa with ≥ 6 eosinophils per high power field and/or eosinophils in colonic crypts or muscularis mucosae. We surveyed all 56 Ohio NASPGHAN members to determine standard practice regarding the evaluation of rectal bleeding in infants. In addition, infants ≤ 6 months old with rectal bleeding were recruited from the referral area of Cincinnati Children's Hospital Medical Center. All infants underwent flexible sigmoidoscopy with biopsies at 5, 10 and 15 cm. Formula or maternal diet was changed only for infants with histologic findings of allergic colitis as defined. Study subjects were followed for 9 weeks.
Results: In the survey of NASPGHAN members, 84% indicated they would empirically change the diet of an infant with rectal bleeding to treat presumed allergic colitis. In our study population, however, only 14 of 22 (64%; 95% confidence interval, 41-83) infants with rectal bleeding had allergic colitis. Five (23%) had normal biopsies and three (14%) had nonspecific colitis. Rectal bleeding in all infants with normal biopsies or nonspecific colitis resolved without diet change except for 1 infant subsequently diagnosed with infantile inflammatory bowel disease.
Conclusion: A significant proportion of infants with rectal bleeding may not have allergic colitis and may undergo unnecessary, expensive formula or maternal diet changes that may discourage breast-feeding.
*Division of Gastroenterology, Hepatology, and Nutrition, †Divison of Pathology and Laboratory Medicine, ‡Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; §Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego, San Diego, California; ∥Division of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Received August 31, 2004; accepted February 15, 2005.
Funding provided in part by USPHS Grant #M01 RR 08084 from the General Clinical Research Centers Program, National Center for Research Resources, National Institutes of Health, Bethesda, Maryland, by training grants T32 DK07727 and T32 ES10957 USPHS Grant R24 BK 064403, and by a gift from Ross Products Division, Abbott Laboratories, Inc., Columbus, Ohio. Alimentum© and Elecare© formulas provided by Ross Products Division, Abbott Laboratories, Inc., Columbus, Ohio.
Address correspondence and reprint requests to Mitchell B. Cohen, Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, MLC 2010, 3333 Burnet Avenue, Cincinnati, OH 45229-3039. (e-mail: firstname.lastname@example.org).