Histological findings in infants with Gastrointestinal food allergy are associated with specific gastrointestinal symptoms; retrospective review from a tertiary centre

BMC Clinical Pathology

Neil J. Sebire²  Mamoun Elawad³  Rosan Meyer³  Robert Dziubak³  Eleni Volonaki³  Osvaldo Borrelli³  Ru-Xin Melanie Foong³  Neil Shah¹ 

[1] Institute of Child Health/UCL, London WC1N 1EH, UK;Histopathology Department, Great Ormond Street Hospital, London, United Kingdom;Paediatric Gastroenterology Department, Great Ormond Street Hospital, London WC1N 3JH, United Kingdom

关键词: Eosinophil;    Histopathology;    Biopsy;    Food allergy;    Infant;    Endoscopy;   

Others  :  1216981
DOI  :  10.1186/s12907-015-0012-6

 received in 2015-02-10, accepted in 2015-06-05,  发布年份 2015

【 摘 要 】

Background

Gastrointestinal food allergy (GIFA) occurs in 2 to 4 % of children, the majority of whom are infants (<1 year of age). Although endoscopy is considered the gold standard for diagnosing GIFA, it is invasive and requires general anaesthesia. Therefore, we aimed to investigate whether in infants with GIFA, gastrointestinal symptoms predict histological findings in order to help optimise the care pathway for such patients.

Methods

All infants <1 year of age over a 20 year period who underwent an endoscopic procedure gastroscopy or colonoscopy for GIFA were evaluated for the study. Symptoms at presentation were reviewed and compared with mucosal biopsy histological findings, which were initially broadly classified for study purposes as “Normal” or “Abnormal” (defined as the presence of any mucosal inflammation by the reporting pathologist at the time of biopsy).

Results

Of a total of 1319 cases, 544 fitted the inclusion criteria. 62 % of mucosal biopsy series in this group were reported as abnormal. Infants presenting with diarrhoea, rectal (PR) bleeding, irritability and urticaria in any combination had a probability >85 % (OR > 5.67) of having abnormal histological findings compared to those without. Those with isolated PR bleeding or diarrhoea were associated with 74 % and 68 % probability (OR: 2.85 and 2.13) of an abnormal biopsy, respectively. Conversely, children presenting with faltering growth or reflux/vomiting showed any abnormal mucosal histology in only 50.8 % and 45.3 % (OR: 1.04 and 0.82) respectively.

Conclusions

Food allergy may occur in very young children and is difficult to diagnose. Since endoscopy in infants has significant risks, stratification of decision-making may be aided by symptoms. At least one mucosal biopsy demonstrated an abnormal finding in around half of cases in this selected population. Infants presenting with diarrhoea, PR bleeding, urticaria and irritability are most likely to demonstrate abnormal histological findings.

【 授权许可】

   
2015 Shah et al.

【 图 表 】

Fig. 1.

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