The Characteristics and Diagnostic Methods of Food Protein Induced Proctocolitis

Ae Suk Kim; Jin-Bok Hwang

doi:10.5223/kjpgn.2011.14.Suppl1.S47

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Kim and Hwang: The Characteristics and Diagnostic Methods of Food Protein Induced Proctocolitis

Review Article

Korean Journal of Pediatric Gastroenterology and Nutrition

Korean Journal of Pediatric Gastroenterology and Nutrition 2011; 14(Suppl 1): S47-S54.

Published online: 31 December 2011

DOI: https://doi.org/10.5223/kjpgn.2011.14.Suppl1.S47

The Characteristics and Diagnostic Methods of Food Protein Induced Proctocolitis

Ae Suk Kim, M.D., Jin-Bok Hwang, M.D.^*

Department of Pediatrics, Dongguk University College of Medicine, Gyeongju, Korea.

^*Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea.

Corresponding author (pedgi@kmu.ac.kr)

Received 7 December 2011 Revised 20 December 2011 Accepted 22 December 2011

Abstract

Food protein induced proctocolitis (FPIPC) is a non-IgE mediated food allergy. FPIPC occurs exclusively among breast-fed infants within the first months of life. FPIPC is often diagnosed clinically in normal-conditioned infants with rectal bleeding. But FPIPC among infancy with rectal bleeding is less general than conceived. The endoscopic findings reveal an edematous and erythematous mucosa with superficial erosions or ulcerations, bleeding and lymphoid nodular hyperplasia. The prominent eosinophilic infiltrates in the rectosigmoid mucosa are important for the histopathologic diagnosis of FPIPC. However, in explaining eosinophilic infiltration within the lamina propria of the mucosa, it is necessary to differentiate whether it is a part of normal findings or occurs due to inflammatory reactions. Oral food challenge and elimination test is performed to identify the same clinical reaction as the symptom of FPIPC by the administration of a specific type of food to infants. The most common causal food is cow's milk. Thus oral food challenge and elimination test can be the effective way of confirming FPIPC, reducing the possibility of misdiagnosis. The purpose of this report is to identify the characteristics of FPIPC, to introduce its diagnostic methods, and to suggest the future direction of research.

Keywords: Food protein induced proctocolitis, Breast-fed infants, Rectal bleeding, Food challenge

Figures and Tables

Fig. 1

Typical endoscopic findings in dietary protein induced proctocolitis, (A) nodular hyperplasia with multiple erosions resembling goose pimply appearance. (B) These findings are prominent in endoscopic deflated state4).

Table 1

Classification of Gastrointestinal Hypersensitivities to Food and Other Dietary Products1)

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