tailieunhanh - Pediatric Just The Facts - part 6

EE là một thực thể lâm sàng khác biệt với một bệnh trào ngược dạ dày thực quản (GERD) như trình bày trong khi eosinophilic gastroenteropathy (EG) trình bày giống như viêm dạ dày. EE được đặc trưng bởi viêm eosinophilic nghiêm trọng của niêm mạc thực quản có lẽ do dị ứng thức ăn nhiều | 310 SECTION 10 GASTROINTESTINAL AND LIVER DISEASE change in 2-3 weeks sigmoidoscopy can document the presence of eosinophilic inflammation as well as exclude other disorders. MILK PROTEIN-INDUCED ENTEROPATHY Milk protein-induced enteropathy typically occurs in infants fed cow s milk formula although it has also been described in soy protein- and breast-fed infants. In the latter transmission of maternal dietary antigens through breast milk has been conjectured. The primary symptoms of vomiting diarrhea and growth failure usually begin soon after birth Table 73-1 . Small bowel injury can present with vomiting diarrhea anemia poor growth from malabsorption and protein-losing enteropathy. Peripheral eosinophilia can be a clue and histologic villous atrophy and intraepithelial lymphocytes help to confirm the diagnosis. A higher prevalence of atopic dermatitis has been reported. Some studies have shown that atopy can be circumvented if predisposed infants are fed breast milk or hydrolysate formulas and introduction of high-risk food antigens milk soy egg gluten and peanut is delayed. Traditional tests for allergy such as IgE-RAST radioal-lergosorbent test and skin prick testing are generally not useful in allergic bowel disorders. Avoidance of intact cow s milk protein through a switch to soy protein or protein-hydrolysate formulas is effective in the majority of infants if successful it can obviate the need for further evaluation. Because up to 35 of infants with cow s milk sensitivity have a concomitant soy allergy soy formulas are not always effective. Those who do not respond to hydrolysate formulas hexapeptide may require more complete elimination of cow s milk antigens in peptide tripeptides or amino acidbased formulas. Most affected infants will require cow s milk protein elimination for the first year of life and outgrow the intolerance by 1-2 years of age. A cow s milk protein challenge may be attempted after a year of age with appropriate monitoring in a .