Food Protein-induced Proctocolitis Research Articles

Analysis of the characteristics of intestinal microbiota after oral tolerance in infants with food protein-induced proctocolitis.

To understand the characteristics of the intestinal microbiota after oral tolerance in infants with food protein-induced proctocolitis (FPIAP) treated with amino acid formula and their differences from healthy children, aiming to provide a scientific basis for guiding the application of probiotics during treatment. FPIAP infants were prospectively enrolled, fecal specimens were obtained, and DNA was extracted for PCR amplification of the bacterial 16S rRNA gene V4 region. Library construction and sequencing were performed, and bioinformatic analysis was performed after obtaining valid data. There were 36 patients in the FPIAP group: 20 males and 16 females, age 21.944 ± 13.277 months. Diarrhea with blood in the stool were the main symptom, with an average course of 14.83 ± 9.33 days. Thirty infants (83.33%) had mucus stool, 11.11% (4/36) of them experiencing vomiting, and 55.56% (20/36) of the infants displaying poor intake and weight gain, 28 (77.78%) patients with moderate eczema, 2 (5.6%) patients with chronic respiratory symptoms. The treatment time with amino acid formula was 5.51 ± 2.88 months. A control group comprising of 25 healthy infants who were full-term, natural delivery, bottle fed, and matched in terms of age (24.840 ± 12.680 months) and gender (15 males and 10 females) was selected. Anaerobic bacteria were less abundant in FPIAP infants than healthy infants (P = 4.811 × 10-5), but potentially pathogenic bacteria were more abundant (P = 0.000). The abundance of Actinobacteria was low in FPIAP infants, the abundance of Proteobacteria was high, and the abundance of Firmicutes was reduced. Bifidobacterium could be used as a bacterial genus to differentiate healthy and FPIAP infants. Both α-and β-diversity indicators of intestinal microbiota were lower in FPIAP infants. In FPIAP infants, glucose and energy metabolism and amino acid anabolism were decreased, and inflammation-related lipopolysaccharide synthesis pathways were increased. Compared with healthy infants, FPIAP infants with oral tolerance after amino acid formula treatment had differences in the structure and diversity of intestinal microbiota, among which Bifidobacterium was significantly reduced. This trial was registered on https://register.clinicaltrials.gov/.

The future of cow's milk allergy - milk ladders in IgE-mediated food allergy.

Cow's milk allergy (CMA) is one of the most common and complex presentations of allergy in early childhood. CMA can present as IgE and non-IgE mediated forms of food allergy. Non-IgE mediated CMA includes food protein-induced enterocolitis syndrome (FPIES), eosinophilic gastrointestinal disorders (EGIDs), and food protein-induced proctocolitis (FPIAP). There are recent guidelines addressing CMA diagnosis, management, and treatment. Each of these guidelines have their own strengths and limitations. To best manage CMA, individualized avoidance advice should be given. Cow's milk (CM) can be replaced in the diet by using hypoallergenic formulas or plant-based milk, depending on factors such as the child's age and their current food intake. Oral and epicutaneous immunotherapy is used to increase tolerance in children with CMA but is not without risk, and the long-term outcome of sustained unresponsiveness is still unclear. The allergenicity of CM proteins are affected differently by different forms of heating, leading to the use of baked milk or milk ladders in the management of CMA, most likely the most promising option for future management and treatment of CMA. Future management of children with CMA will also include discussion around the immunomodulatory potential of the child's dietary intake.

Food Protein-Induced Proctocolitis: A Unique Subtype of Gastrointestinal Non-IgE-mediated Food Allergy

Food Protein-Induced Proctocolitis: A Unique Subtype of Gastrointestinal Non-IgE-mediated Food Allergy

INDUCED PROCTOCOLITIS - ORAL FOOD CHALLENGE SHOULD BE DONE TO CONFIRM THE DIAGNOSIS OF COW'S MILK ALLERGY IN NEONATES?

Suspicion of food protein-induced proctocolitis based on empirical understanding of rectal bleeding can lead to misdiagnosis. to verify clinical and evaluative characteristics of patients who presented neonatal rectal bleeding and were on a restricted cow's milk diet. A cross-sectional retrospective study included patients followed up in a tertiary care center, who presented rectal bleeding in the neonatal period. The analyzed data included gender, gestational age, type of delivery, use of antibiotics during the last trimester of pregnancy, use of parenteral nutrition before the first manifestation, use of mechanical ventilation, initial clinical manifestations associated with rectal bleeding, diet before the first manifestation, period of elimination diet, oral food challenge (OFC) results and symptoms presented in cases of positive OFC. Fisher's exact test and Mann-Whitney test were used to analyze the data. The level of significance was set to 5%. Forty-two patients were selected: 30 preterm infants, 34 cesarean deliveries, 10 exclusively breastfed patients before rectal bleeding. Median age at OFC was 6.3 months old. Median of length of the elimination period before OFC was 5.9 months. OFC was negative in 33/42 (79%) patients and positive in 9/42 (21%). There was no association between OFC results and the evaluated data. The main symptom observed in patients with positive OFC was blood in stools. OFC was negative in most cases of suspected cow's milk allergy due to rectal bleeding in neonates, most of them with a history of prematurity.

Features of intestinal flora in children with food protein-induced proctocolitis based on high-throughput sequencing

To study the features of intestinal flora in children with food protein-induced proctocolitis (FPIP) by high-throughput sequencing. A total of 31 children, aged <6 months, who experienced FPIP after exclusive breastfeeding and attended the outpatient service of the Third Affiliated Hospital of Zunyi Medical University from October 2018 to February 2021 were enrolled as the FPIP group. Thirty-one healthy infants were enrolled as the control group. Fecal samples were collected to extract DNA for PCR amplification. High-throughput sequencing was used to perform a bioinformatics analysis of 16S rDNA V3-V4 fragments in fecal samples. The diversity analysis of intestinal flora showed that compared with the control group, the FPIP group had a lower Shannon index for diversity (P>0.05) and a significantly higher Chao index for abundance (P<0.01). At the phylum level, the intestinal flora in both groups were composed of Firmicutes, Actinobacteria, Proteobacteria, and Bacteroidetes. Compared with the control group, the FPIP group had a significant reduction in the composition ratio of Actinobacteria (P<0.001) and a significant increase in the composition ratio of Proteobacteria (P<0.05). At the genus level, the intestinal flora in the FPIP group were mainly composed of Escherichia, Clostridium, Enterococcus, Klebsiella, and Bifidobacterium, and the intestinal flora in the control group were mainly composed of Bifidobacterium and Streptococcus. Compared with the control group, the FPIP group had a significant reduction in the composition ratio of Bifidobacterium and Ruminococcus (P<0.05) and significant increases in the composition ratios of Clostridium and Shigella (P<0.05). Compared with the control group, the FPIP group has a reduction in the diversity of intestinal flora and an increase in their abundance, and there are certain differences in several bacterial genera. These results suggest that changes in the composition of intestinal flora at genus level may play an important role in the development and progression of FPIP.

Using Eosinophil Biomarkers From Rectal Epithelial Samples to Diagnose Food Protein-induced Proctocolitis: A Pilot Study.

The gold standard diagnostic procedure for food protein-induced proctocolitis (FPIP) requires flexible sigmoidoscopy (FS). To date there is no validated, noninvasive test to confirm FPIP diagnosis. Eosinophil-derived neurotoxin (EDN), a product of eosinophil (EOS) degranulation, has been shown to correlate with eosinophil infiltration in other tissues. Our objective was to compare EDN concentrations in rectal epithelial samples from infants with FPIP with those from a control population. Children who underwent routine FS at Arnold Palmer Hospital for Children were enrolled in an IRB-approved, prospective, open-label pilot study between July 2017 and May 2019. We obtained rectal epithelial samples via: rectal swab, cytology brushing through FS, and rectal biopsy through FS. We then measured EDN levels in the samples and compared levels found in infants with FPIP against levels found in the control group. FPIP was defined as more than 60 EOS per 10 high-power fields (HPF) in rectal epithelial tissue obtained via rectosigmoid biopsy. Twenty-four patients were enrolled. The control group (n = 13) included patients with normal histopathology (84% boys, mean age 19 months, SD 6 months) and the FPIP group (n = 11) included patients with FPIP confirmed via biopsy (45% boys, mean age 6.9 months, SD 9 months). EDN concentration was significantly higher in the FPIP group than in the control group, for 2 sampling methods: rectal biopsy (183.6 ± 114.6 vs 76.6 ± 71.0 μg/mL; P = 0.010) and rectal swab (66.2 ± 64.8 vs 20.4 ± 22.2 μg/mL; P = 0.025). EDN concentrations measured from rectal swab and rectal biopsy samples is elevated and may be a useful tool to screen for FPIP in children.

Risk factors of delayed tolerance in children with cow milk protein allergy attending gastroenterology clinic in Alexandria University Children’s Hospital

Background Cow’s milk protein allergy (CMPA) is the most common type of food allergy. The prevalence is increasing in both developing and developed countries. The clinical presentations are variable in intensity and may involve many different organ systems. The diagnosis depends on positive response to an elimination diet, with recurrence of the symptoms upon re-challenge. CMPA usually resolves during early childhood, but some factors may delay the acquisition of tolerance. Aim The aim was to investigate the possible risk factors that may be associated with delayed tolerance to cow’s milk in patients with CMPA. Patients and methods The study included 95 patients aged 1 month to 3 years with proved CMPA attending the Gastroenterology Clinic at Alexandria University Children Hospital. Cases were recruited for 6 months, starting from January 1, 2018, to the end of June 2018. The demographic data, age at onset, clinical presentations, nutritional history, and family history of atopy were reported. The diagnosis was confirmed through elimination-re-challenge trial. All patients were treated by a milk-free diet with the use of appropriate milk substitutes according to the age. After a 6–9-month period of elimination, gradual re-introduction of milk was attempted, and the development of tolerance to milk was evaluated. Factors associated with delayed tolerance were compared in both the tolerant and intolerant groups. Results At their initial visit, the mean age of the studied patients was 8.5±4.9 months, and 17.9% were underweight. The mean age at onset of symptoms was 2.2±2.2 months, whereas the mean duration before diagnosis was 3.3±2.8 months. Overall, 85.3% were born via cesarean section. Chronic or delayed symptoms were reported in 93.7%. All patients had gastrointestinal symptoms. Chronic diarrhea was the commonest symptoms (90.53%) followed by vomiting (42%). In addition, 28.4% had cutaneous symptoms. Moreover, 81% were formula fed. Food protein-induced proctocolitis was the most common syndrome among patients with chronic symptoms. Overall, 85.26% of them were born via cesarean section. Early introduction of dairy products was encountered in 37.9%. In addition, 10% of the patients had cross-reaction to soy and 14.5% had multiple food allergy (MFA). Additionally, 56.8% had a family history of atopy. Overall, 68.42% tolerated cow milk after gradual re-introduction. Delayed diagnosis of CMPA symptoms, delayed introduction of complementary food, rural residence, family history of atopy, cross-reactivity to soya or MFA were associated with delayed tolerance to cow’s milk. Patients with immediate symptoms [immunoglobulin (Ig)E mediated] or food protein-induced enterocolitis syndrome or those with CMPA-associated eosinophilic gastrointestinal disorders showed delayed tolerance. Tolerance was achieved more frequently in patients with delayed (non-IgE mediated) symptoms, in patients with exclusive gastrointestinal symptoms, and in patients with food protein-induced proctocolitis. Conclusion The tolerance rate after 6–9 months of elimination was 63.2%, which is comparable to the international rates. IgE-mediated CMPA, food protein-induced enterocolitis syndrome, CMPA-associated eosinophilic gastrointestinal disorders, and MFA have delayed tolerance.

Food Protein-Induced Proctocolitis

The article reflects the modern views on food protein induced proctocolitis: prevalence, pathophysiological mechanisms of intestinal damage, clinical manifestations, main food allergens that contribute to the development of this pathological condition, approaches to diagnosis and diet therapy. The article describes a clinical case of food protein induced proctocolitis in a child of the 1st year of life.

Causes of hematochezia and hemorrhagic antibiotic-associated colitis in children and adolescents.

Diseases causing hematochezia range from benign to potentially life-threatening. Systematic pediatric data on the causes of hematochezia are scarce. We studied the underlying causes and long-term outcome of hematochezia in children. We further investigated the relevance of antibiotic-associated hemorrhagic colitis in children, especially if caused by Klebsiella oxytoca.Infants, children, and adolescents with hematochezia were recruited prospectively. Patients were grouped according to age (<1 year, 1-5 years, 6-13 years, >14 years). In addition to routine diagnostics, K oxytoca stool culture and toxin analysis was performed. We collected data on history, laboratory findings, microbiological diagnostic, imaging, final diagnosis, and long-term outcome.We included 221 patients (female 46%; age 0-19 years). In 98 (44%), hematochezia was caused by infectious diseases. Endoscopy was performed in 30 patients (13.6%). No patient died due to the underlying cause of hematochezia. The most common diagnoses according to age were food protein-induced proctocolitis in infants, bacterial colitis in young children, and inflammatory bowel disease in children and adolescents. Seventeen (7.7%) had a positive stool culture for K oxytoca. Antibiotic-associated colitis was diagnosed in 12 (5%) patients: 2 caused by K oxytoca and 2 by Clostridium difficile; in the remaining 8 patients, no known pathobiont was identified.Infections were the most common cause of hematochezia in this study. In most patients, invasive diagnostic procedures were not necessary. Antibiotic-associated hemorrhagic colitis caused by K oxytoca was an uncommon diagnosis in our cohort. Antibiotic-associated colitis with hematochezia might be caused by pathobionts other than C difficile or K oxytoca.

Food Protein Induced Proctocolitis: A Benign Condition with an Obscure Immunologic Mechanism

Food protein-induced proctocolitis (FPIP) is the most common colonic manifestation of food allergy in infants, accounting for up to 60% of exclusively breast-fed children. The causative foods derived from the mother's diet, which are then excreted in her milk. The suggested risk factors for the development of FPIP are an immature immune system, altered intestinal permeability and other factors that activate local immune function, such as genetic susceptibility in combination with particularly sensitizing foods. FPIP is an enhanced immune responsiveness of some infants to very small amounts of food antigens, inducing an inflammatory mucosal response, mediated by T cells.

Evaluation of Our Food Protein Induced Proctocolitis Cases: A Single Center Experience

Aim: The purpose of this study was to determine clinical characteristics, laboratory findings and course in infants diagnosed with allergic proctocolitis. Materials and methods: Thirty-four patients diagnosed with food protein-induced proctocolitis in our clinic between 2013 and 2016 were evaluated retrospectively. Files were reviewed in terms of symptoms, clinical features, laboratory findings and responses to treatment. Results and discussion: Sixteen (47%) patients were female. Mean age was 3.3 ± 2.3 months (1-10 months). Eleven (32.3%) cases presented with pronounced rectal bleeding and 23 (67.6%) with bloody spots or streaks in stool. In terms of nutrition, 76.4% of babies were receiving breast milk alone, and the remainder received breast milk with supplementary formula. Mean peripheral eosinophil rate was 8.6 ± 6.3%. Response was achieved solely by removal of milk and dairy products from the mother’s diet in 25 (73.5%) cases, while multiple allergen food (eggs, nuts, fish etc.) elimination was applied to mothers in 8 (23.5%) and breast milk was discontinued for 3 months in one case. Symptoms resolved in a mean 6.4 ± 5.9 days (1-25) following of elimination diet. Conclusion: Our study shows that allergic proctocolitis in infancy frequently appears in exclusively breastfed babies, that the condition has a benign course and that cow’s milk protein plays an important role in the etiopathogenesis.

Clinical characteristics and etiology analysis of 223 children undergoing colonoscopy

Objective To investigate the clinical characteristics and etiology in infants undergoing colonoscopy in order to improve the understandings of lower gastrointestinal tract diseases and their endoscopic manifestations. Methods The clinical and endoscopic data of the infants aged ≤3 years old who underwent conoloscopy at the Department of Gastroenterology, Children′s Hospital of Chongqing Medical University, from July 2010 to December 2014, were retrospectively analyzed.A total of 223 children were included, 148 male and 75 female.The age range was from 26 d to 3 years old(<6 months: 41 cases; 6-12 months: 68 cases; 1-3 years old: 114 cases). Results A total of 235 colonoscopies were performed under deep sedation by single or double manipulators.Cecal intubation was successful in 192 colonoscopies and terminal ileal intubation was completed in 29 colonoscopies, with a high success rate of 94.0%(221/235 colonoscopies). The main symptoms included hematochezia(124 cases, 55.6%), persistent/chronic diarrhea(55 cases, 24.7%), hematochezia with chronic diarrhea(22 cases, 9.5%), and others(22 cases, 9.5%). Of the 223 patients, clear diagnosis were established for 215 children(96.4%), with food protein-induced proctocolitis (FPIPC) (78/223 cases, 35.0%), colonic polyps (50/223 cases, 22.4%), colitis(29/223 cases, 13.0%), antibiotic associa-ted diarrhea (AAD) (19/223 cases, 8.5%), FPIPC with AAD (10/223 cases, 4.5%). Conclusions Colonoscopy serves as a very important tool for the accurate diagnosis of lower gastrointestinal diseases with hematochezia and/or chronic diarrhea.FPIPC and colonic polyps are the most common causes for hematochezia and/or chronic diarrhea.AAD may be another important cause of chronic diarrhea and bloody stool in infants.Moreover, ghe application of colonoscopy in combination with histopathology can also play an important role in the diagnosis of some rare diseases, such as intestinal tuberculosis, primary intestinal lymphangiectasia, Behcet′s disease and primary immunodeficiency disease. Key words: Infant; Colonoscopy; Hematochezia; Chronic diahrrhea

Eosinophilia in infants with food protein-induced enterocolitis syndrome in Japan

BackgroundMany Japanese infants with food protein-induced enterocolitis syndrome (FPIES) show eosinophilia, which has been thought to be a characteristic of food protein-induced proctocolitis (FPIP). MethodsTo elucidate the characteristics of eosinophilia in Japanese FPIES patients, 113 infants with non-IgE-mediated gastrointestinal food allergy due to cow's milk were enrolled and classified into FPIES (n = 94) and FPIP (n = 19). ResultsThe percentage of peripheral blood eosinophils (Eo) was increased in most FPIES patients (median, 7.5%), which was comparable with that in FPIP patients (9.0%). Among FPIES patients, Eo was the highest in patients who had vomiting, bloody stool, and diarrhea simultaneously (12.9%) and lowest in patients with diarrhea alone (3.2%). Eo showed a significant positive correlation with the incidence of vomiting (Cramer's V = 0.31, p < 0.005) and bloody stool (Cramer's V = 0.34, p < 0.0005). A significant difference was found in Eo between early- (≤10 days, n = 56) and late-onset (>10 days, n = 38) FPIES (median, 9.8% vs. 5.4%; p < 0.005). IL-5 production by peripheral blood T cells stimulated with cow's milk protein in early-onset FPIES was significantly higher than that in late-onset FPIES (67.7 pg/mL vs. 12.5 pg/mL, p < 0.01), and showed a significant positive correlation with Eo (rs = 0.60, p < 0.01). ConclusionsThis study demonstrated two types of eosinophilia in Japanese FPIES infants: conspicuous and mild eosinophilia in early- and late-onset FPIES patients, respectively. Conspicuous eosinophilia in early-onset FPIES is suggested to be caused by abnormally high IL-5 production.

Serum C-reactive protein in food protein-induced enterocolitis syndrome versus food protein-induced proctocolitis in Japan.

Some infants with food protein-induced enterocolitis syndrome (FPIES) have increased serum C-reactive protein (CRP) and fever in Japan. The aim of this study was therefore to clarify and compare the incidence of this in patients with FPIES versus patients with food protein-induced proctocolitis (FPIP). One hundred and sixteen infants with non-IgE-mediated gastrointestinal food allergies were enrolled in this study and classified into three phenotypes: FPIES presenting with vomiting and/or diarrhea (n = 47); FPIP with bloody stool alone (n =19); and the mixed phenotype (MP), bloody stool with vomiting and/or diarrhea (n = 50). Serum CRP was increased in 55.3% of the FPIES group, similar to that in the MP group (54.0%), and significantly higher than in the FPIP group (15.8%; P < 0.01). Fever was observed in 29.8% of the FPIES group, significantly higher than in the MP group (8.0%; P < 0.01) and in the FPIP group (0%; P < 0.05). Patients with fever had significantly higher serum CRP than patients without fever (median, 12.8 vs <0.2 mg/dL, P < 0.00001). Serum CRP was significantly higher in the FPIES group than in the FPIP group. This suggests that serum CRP is a useful marker for differentiating the pathogenesis of FPIES from FPIP. From the perspective of serum CRP, the pathology of the intestinal inflammation in MP subjects is suggested to be similar to that of FPIES.

Food allergy and the related diseases of digestive system

Food allergy refers to the body's abnormal immune response to food, which induces disorder and/or injuries of human body, and thus triggers a series of manifestations.Ninety percent of food allergy is due to the following allergen: milk, eggs, peanuts, nuts, seafood, soy, wheat, etc.The symptoms of digestive system are closely associated with the nature of allergen (including protein's family nature, three dimensional structure, biological activity and stability) and the body's own status (genetic factors, integrity of intestinal mucosal barrier and oral immune tolerance). The symptoms of digestive systems are not typical, and differ by various factors like body conditions, ages, regions and allergens, so the diagnosis is difficult.Food allergy is categorized by its mechanism: IgE, non IgE, and mix.The symptoms of digestive systems include vomiting, diarrhea, reflux, constipation and abdominal pain, etc, and relative diseases include food protein-induced enteropathy, food protein-induced enterocolitis syndrome, food protein-induced enterocolitis syndrome, food protein-induced proctocolitis, celiac disease, eosinophilic gastroenteritis, eosinophilic esophagitis and infantile colic, etc.Delayed diagnosis will result in failure to thrive, anemia and hypoproteinemia.Therefore, early diagnosis and treatment can effectively prevent malnutrition and improve the children's animation. Key words: Food allergy; Digestive systems; Child

Alergiczne zapalenie prostnicy i okrężnicy u dzieci jako objaw kliniczny alergii IgE-niezależnej

Food protein-induced proctocolitis is a cell-mediated allergic inflammatory process involving the rectum and usually the distal part of sigmoid colon. The disease occurs both in formula-fed children as well as in breastfed infants. The symptoms are usually mild and self-limited, manifested by the presence of a small amount of blood in the stool. The disease is most often caused by hypersensitivity to cow's milk protein. Diagnosis is based on the finding of typical symptomatology after ingestion of certain food and the only diagnostic and therapeutic procedure in the majority of patients is the use of a non-dairy elimination diet. Severe course of this illness or the lack of improvement after applying of non-dairy diet requires further diagnostics and allows the temporary use of elementary diet.

Outcome of infants presenting rectal bleeding: a retrospective study in a single institution.

Although rectal bleeding in infancy (RBI) is not a rare phenomenon, the clinical course of RBI is not fully understood. To investigate the outcome and pathogenesis of RBI, especially when concomitant with food-protein-induced proctocolitis (FPIP) and neonatal transient eosinophilic colitis (NTEC), 22 neonates with rectal bleeding with FPIP and NTEC from January 2008 to June 2012 were enrolled and their clinical course and mechanisms of inflammation were examined. Thirteen infants showed rectal bleeding after feeding and were diagnosed with FPIP, and nine infants showed rectal bleeding before feeding and were diagnosed with NTEC. Elevated peripheral white blood cell (12,685 ± 3754/μl and 30,978 ± 16,166/μl) and eosinophil (1084 ± 816/μl and 4456 ± 3341/μl) were confirmed in FPIP and NTEC, respectively. Colonoscopy revealed nodular lymphoid hyperplasia, a pale mucosal surface and oozing with diffuse infiltration of neutrophils, lymphocytes, and eosinophils in both groups. Reverse transcription polymerase chain reaction analysis revealed enhanced expression of the interleukin-6, CCL11, and CXCL13 genes, where CXCL13 expression was more prominent in FPIP. Mucosal infiltration by CD3- and immunoglobulin-A- but not immunoglobulin-E-positive cells was confirmed. Among them, only one infant with FPIP developed milk allergy, whereas none with NTEC had developed milk allergy at the age of 1 year. FPIP in infancy and NTEC are similar diseases and interleukin-6, CCL11, and CXCL13 may play a major role in the pathogenesis of rectal bleeding. Although the involvement of allergic reaction is possible, milk allergy was not a common outcome after 1 year of follow up.

Evaluation of a free amino acid-based formula in infants with presumptive food protein-induced proctocolitis.

Objective:Food protein–induced proctocolitis usually occurs early in life and is characterized by blood-streaked stools and pain during defecation in an otherwise healthy infant. While many infants with food protein–induced proctocolitis respond well to a casein hydrolysate formula, some require an amino acid–based formula. The objective of the study was to measure the change in physician-rated symptom score from enrollment to study completion in infants with presumptive food protein–induced proctocolitis fed with a specific amino acid-based formula.Methods:In this study, infants ≤6 months of age diagnosed with presumptive food protein–induced proctocolitis received an amino acid-based formula for 42 days. Intake, stool patterns, weight, stool occult blood, and questionnaires assessing infant feeding and stool patterns and parental formula satisfaction were collected.Results:The full analysis set included 43 infants. The mean age at enrollment was 59 ± 5 days. A significant improvement was observed from enrollment to exit in physician-rated symptom score (9.1 ± 0.5 to 4.8 ± 0.5, p < 0.0001), the number of infants with occult blood in stool, and weight-for-age Z-scores during the study. Parental satisfaction with the formula was high.Conclusion:The results confirm that the amino acid-based formula studied is efficacious for managing symptoms of presumptive food protein–induced proctocolitis.

Tu1932 Endoscopic Features of Food Protein-Induced Proctocolitis in Neonates and Infants

Background and aim: Intestinal-type gastric carcinomas progress through chronic inflammation and atrophic gastritis. Heat shock protein 27(HSP27), a stress-induced molecular chaperone, inhibit reactive oxygen species (ROS) accumulation. In previous reports have been suggested that HSP27 plays an important role in inflammation and carcinogenesis. We investigated HSP27 expression in gastric neoplasia and background gastric mucosa to assess its involvement in gastric carcinogenesis. Methods:We used real-time quantitative polymerase chain reaction to examine HSP27 expression in gastric neoplasias and in gastric mucosae of 30 patients with intraepithelial neoplasias and in gastric mucosae of 30 patients without gastric neoplasia. Immunohistochemical staining was performed on 30 advanced gastric cancer tissues. Results: HSP27 expression was negatively associated with atrophic gastritis. HSP27 expression in the background gastric mucosa of those without gastric neoplasia(P= 0.004).In tumor necrosis factor -treated gastric cancer cell,HSP27 knockdown increased cell death and ROS accumulation that link inflammation to cancer. Poorly differentiated tumors most frequently had high HSP27 levels. Dedifferentiated of cancer cells is associated with an epithelial-mesenchymal transition signaling pathway. In gastric cancer MKN-1 cells, HSP27 knockdown upregulated E-cadherin and downregulated vimentin and smooth muscle actin, but this did not occur in MKN-74 cells. Conclusion: HSP27 expression in gastric mucosae is negatively correlated with intraepithelial neoplasia, a probable precursor to gastric cancer and HSP27 expression in cancer is positively correlated with poor differentiation.

Food protein-induced proctocolitis: Is this allergic disorder a reality or a phantom in neonates?

The etiology of small and fresh rectal bleeding in neonates who are not sick is usually unknown; the only known cause is food protein-induced proctocolitis (FPIPC). It has been recently reported that FPIPC is a rare cause of rectal bleeding in newborns, and most cases have been proved to be due to idiopathic neonatal transient colitis. A recommended strategy for diagnosing suspected FPIPC in neonates is as follows. During the early stage, the etiology of small and fresh rectal bleeding in an otherwise healthy newborn need not be studied through extensive investigations. In patients showing continued bleeding even after 4 days, sigmoidoscopy and rectal mucosal biopsy may be performed. Even if mucosal histological findings indicate a diagnosis of FPIPC, further oral food elimination and challenge tests must be performed sequentially to confirm FPIPC. Food elimination and challenge tests should be included in the diagnostic criteria of FPIPC.