Abstracts: Annual Meeting of the North American Society for Pediatric Gastroenterology and Nutrition; Denver, October 21-24, 1999
Background: When visible/occult blood is found in stools of exclusively breast-fed (EBF) infants, it is often due to cow-milk/soy protein-induced allergic colitis. Elimination of antigens from the maternal diet usually leads to rapid resolution. If blood persists despite further maternal dietary restrictions, physicians might advise mothers to stop breast-feeding and substitute with hypo-/mon-allergenic formula. Pancreatic enzymes have been used by some to treat eczema due to food protein allergy. The protease component is postulated to break down offending proteins rendering them less antigenic. Aim: To determine if persistent stool blood in the EBF infant, despite careful maternal dietary restriction, resolves by providing pancreatic enzymes to the mother. Methods: Four term EBF infants (ages 1.5-3mos.) were evaluated for visible/occult stool blood despite maternal dietary restriction of cow-milk/soy protein. No mother had cracked/sore nipples. All infants had a positive atopic family history but no anal fissure or stool pathogens were found. Further restriction of egg, wheat, fish, nuts and peanuts (≥ two weeks) did not eliminate stool blood. Dietary compliance was monitored by a dietitian. Due to irritability, GE reflux, diarrhea and hematochezia, two infants had endoscopy revealing allergic colitis. Mothers were then prescribed pancreatic enzymes (Pancrease MT 4®, USP Units: 4,000 lipase/12,000 amylase, 12,000 protease) two capsules with meals/one with snacks. Stool blood was followed two to three times/week by guaiac (Hemoccult®) testing. Results: In ¾ infants, stool blood resolved within a few days of therapy. One mother required three capsules with meals/two with snacks before stool blood resolved. No side-effects occurred due to therapy. Conclusion: Maternal pancreatic enzyme therapy can be an alternative treatment for EBF infants with stool blood when dietary restriction fails. It allows mother to continue to breastfeeding and to reduce the risk of anemia.