| Objective: To analyze and summarize the clinical manifestations of food protein-induced Proctocolitis(FPIP),meaningful diagnostic methods,effective treatment and prognosis,and to increase the awareness of clinicians on the disease.Methods: Including peripheral blood analysis,stool routine + occult blood,stool culture,biochemical test kit,serum allergen s Ig E test,skin prick test and patch test,intestinal flora analysis,electron colonoscopy,and histopathological examination of intestinal mucosa of children diagnosed as FPIP were enrolled in Children's Hospital of Chongqing Medical University from November 2012 to October 2017.Giving avoidance of sensitized foods and/or the children with special milk powder,the diagnosis of open provocation test was performed after the symptoms relieved.Following up once every 3 to 6 months,gradually adjust the diet formula until tolerance?Results:(1)General situation: 270 cases in this group,133/270 cases(49.26%)were exclusively breastfed,80/270 cases(29.63%)were mixed and 57/270 cases(21.11%)were artificially fed.There were 130 /270 patients who had a clear cause before the onset of illness.Among them,41 /130 were added or replaced with powdered milk,31/130 supplemental foods such as eggs and fish were added,and 58/130 breastfeeding mothers did not evade diet recently?(2)Clinical manifestations: Children with FPIP were mainly characterized by diarrhea and blood in the stool.There were 194/270 cases of diarrhea,most of them were sparse/diluted watery stools,and the frequency was variable.The number of patients infected with rotavirus was frequent and ranged from 10 to 20 times/day.In 220/270 cases of stool blood,there were bloodshot in the stool(intermittently appeared from the stool.With a small amount of blood to more blood-based stool,most of the visible mucus,with or without changes in stool frequency;abdominal distension in 7/270 cases,5/270 cases of constipation,fever in 18/270 cases,accompanied by vomiting in 18/270 cases,34/270 cases of anemia,Malnutrition occurred in 8/270 patients(3/8 mild cases,2/8 moderate cases,3/8severe cases),and 5/270 cases of hypoalbuminemia.There were 94/270 cases with a course of less than 2 weeks,145/270 cases from 2 weeks to 2 months,and 31/270 cases more than 2 months.(3)Laboratory examination: There were 140/270 cases of elevated white blood cells in the blood routine,with fluctuations of(10.05-30.88)*10^9/L,108/270 cases of lymphocytes,and 32/270 cases of neutrophils;221/270 cases of elevated platelet,fluctuations in(302-730)* 10^9/L;44/270 cases of hemoglobin decreased,there were 22 cases of 1-4 months of FPIP infant whose hemoglobin less than 90g/L,fluctuations of 72-89 g/L,among the remaining 22 cases,15/22 cases of mild anemia,6/22 cases of moderate anemia,1/22 case of severe anemia;the percentage of eosinophils is increased by 174/270 cases,fluctuations At(0.05-6)%.Hepatic function tests revealed that there were 5/270 cases of albumin reduction,fluctuating at(26.5-29.9)g/L.In the stool examination,there were 41/270 white blood cells(+--+++)and 167/247 cases of occult blood positive.All the children in this group had normal stool culture and large invasive bacterial culture.Some of the children were tested for fecal rotavirus antigen and reducing sugar,rotavirus antigen was 29/114(25.4%),and reducing sugar test was positive for 89/117(52%).(4)Flora analysis: In this group,125/270 cases of FPIP children were analyzed for fecal flora.The results suggested that there were 3 /125 cases of normal,20 /125 cases of I degree dysbacteriosis,96 /125 cases of II degree dysbacteriosis,and III degree dysbacteriosis In 6 /125 cases,most indicated that the total number of bacteria decreased in 116/125 cases(92.8%),G+ bacilli decreased in 108/125 cases(86.4%),G-bacilli decreased in 107/125 cases(85.6%),and G+ cocci increased in 102/125 cases(81.6%),among which intestinal Streptococcus dominated,G-coccus did not change in 117/125 cases(93.6%),part of the G+ crude bacillus and yeast.The 125 patients undergoing microbiota screening examination had 57/125 cases of antibiotics before admission.Among them,31/57 cases were cephalosporins,4/57 cases were penicillins,8/57 cases were two or more antibiotics,and the course of treatment was 5-20 days.The types and course of treatment were unknown in14/57 cases.(5)food allergen examination: 106/270 cases of this group of children with serum s Ig E detection,76/106 cases of negative,milk allergy in 9/106 cases,8/106 cases of fish,peanuts in 5/106 cases,4/106 cases of soybean,3 cases of eggs;skin prick 18/270 cases were tested,7/18 cases were negative,milk allergies were in 8/18 cases,milk+seafood,milk+soybeans,milk+eggs,milk+peanuts,soybeans+wheat,peanuts,eggs were 2/18 cases respectively;patch tests were performed in 3/270 cases,1/3 case was normal,1/3 case was allergic to milk and eggs,and 1/3 case was allergic to milk and soybean.(6)Imaging examination: Abdominal ultrasound was performed in 130/270 cases.The results showed partial effusion in 4/130 cases,a small amount of peritoneal effusion in 1/130 case,thickening of the intestinal wall in 1/130 case,separation of renal pelvis in 5/130 cases,and 119/130 cases(91.53%)no obvious abnormalities were found;in 66/270 cases patients who underwent abdominal examinations,no organic lesions were suggested.(7)Colonoscopy and mucosal biopsy: 61/270 FPIP patients underwent colonoscopy.The colorectal mucosal congestion and edema were seen under the microscope.Among them,39/61 cases had rash-like erythema and erythema.9/61 cases showed erythematous irregular erythema and 5/61 cases.A coarse grainy uplift was seen,2/61 cases were accompanied by pseudomembranous colitis,and white colonies were visible on the colon.6/61 cases only showed mucosal congestion and edema.Of the 61 patients,55/61(93.44%)had total colon involvement,2/61 had rectal + sigmoid involvement,2/61 had rectal + sigmoid + descending colon + transverse colon involvement,and 2/61 had total colon + appendix The opening + ileocecal mucosal involvement.In 57/61 routine intestinal mucosa biopsy,mononuclear cells and lymphocytes were infiltrated in the intestinal lamina propria,of which 5/57 cases were accompanied by lymphoid follicle formation and 2/57 lymphoid follicles + neutrophil infiltration,7/57 cases with neutrophils + eosinophil infiltration,1/57 with lymphoid follicles + eosinophils,7/57 cases with neutrophils + eosinophils + lymphoid follicle infiltration,35/57 cases under the microscope can be seen in different degrees of eosinophil infiltration.(8)Treatment and outcome: All the 270 children had relief from symptoms after food avoidance.The mothers who continued breastfeeding strictly avoided sensitized foods in 40/270 cases(12.96%)and 13/270 cases(52.22%)of deeply hydrolyzed protein powder and 85/270 cases(31.48%)was changed to amino acid milk powder feeding and suspicious supplementary food was avoided in 4/270 cases(1.48%).All children were given probiotics to regulate intestinal flora.Two patients with antibiotic-associated diarrhea were treated with metronidazole and oral anti-infection.There were 46/270 cases(17.04%)of treatment improvement time less than 3 days,159/270 cases(58.89%)of 4-7 days,60/270 cases(22.22%)of 8-14 days,and 5/270 cases(1.85%)of more than 14 days.After the improvement of symptoms,there were 28/270 cases of children who had returned to the hospital for food provocation test,18/28 cases(64.29%)were negative,10 /28 cases(35.71%)were positive,and there were 4/10 cases of changes in stool frequency and traits after food stimulation,3/10 cases of newly developing eczema,2/10 cases of eczema and diarrhea,and 1/10 cases of eczema and respiratory secretions increased.One patient with colonoscopy before treatment showed erosive colorectal inflammation,active inflammation of the colon,symptomatic relief after feeding amino acid milk powder and avoiding sensitized foods,and reexamination of endoscopy after 30 days revealed normal colorectal mucosa.Conclusion:The features of infants with FPIP induced by food protein is recurrent hemafecia,colon and rectum diffuse changes and eosinophil infiltration,eosinophilic cell and platelets of capillary blood increased.After removal of milk protein from breast milk and food 48-72 h,the symptom relief is helpful in the diagnosis.Dietary intervention is the most effective treatment,because of making infants get tolerance gradually and prognosis better. |
PDF Full Text Request