PROCTOCOLITIS IN EXCLUSIVELY BREAST-FED INFANTS

We present nine exclusively breast-fed, full-term infants with mild re ctal bleeding due to proctocolitis. The mean age at the onset of sympt oms was 5 weeks (range 1-8 weeks). Rectosigmoidoscopic examination was performed in all children within 2 days after admission, showing infl ammatory changes such as oedematous mucosa with petechial haemorrhages . Rectal mucosal biopsy specimens were obtained in eight cases and rev ealed intra-epithelial eosinophilic granulocytes in seven and a diffus e increase of eosinophils in the lamina propria in six. Allergy to cow 's milk protein transferred to the infants via the breast milk was bel ieved to be the cause of the inflammation. The intake of cow's milk pr otein was then restricted in seven mothers. Following this regimen, sy mptoms were relieved within 4 weeks in the six infants who were seen a t follow up, One child recovered spontaneously without dietary restric tions. Considering the beneficial effect of the diet regimen in additi on to the histological findings, allergy to cow's milk protein is poss ibly the aetiology of the proctocolitis seen in these nine exclusively breast-fed babies, although no challenge tests were performed to conf irm this suspicion, Conclusion This report shows that proctocolitis oc curs in exclusively breast-fed infants. It is speculated that allergy to cow's milk protein may have played a role in the pathogenesis.