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Colite néonatale par allergie aux protéines du lait de vache

Cow’s milk protein-induced colitis of early infancy

  • Published:
Acta Endoscopica

Résumé

La survenue de rectorragies en période néonatale doit, après avoir éliminé une entérocolite ulcéro-nécrosante (ECUN), faire évoquer entre autre une colite au lait de vache (LV). 33 nouveau-nés présentant une colite par allergie au LV prouvée sont décrits cliniquement et endoscopiquement. Tous les cas, en effet, obéissent aux critères diagnostiques de l’ESPGAN. 66,4 % d’entre eux ont manifesté l’affection avant l’âge de 15 jours. 12 sont nés prématurément, dont 7 étaient exclusivement nourris au lait maternel. Les principaux signes associés étaient de la diarrhée (60 %), des vomissements (42,4 %), un gain pondéral insuffisant (30 %). Deux des prématurés ont développé une ECUN concomitante qui a conduit à un grêle court dans 1 cas et une sténose colique dans l’autre. Dans tous les cas, la muqueuse rectosigmoïdienne était érythémateuse, suintante et œdématiée avec, en outre, une friabilité excessive dans 15 cas et des micro-ulcérations dans 8. Chez les 7 enfants où elle a pu être pratiquée, la biopsie a révélé un infiltrat inflammatoire de gravité variable et dans 2 cas des abcès cryptiques.

Dans tous les cas, en dehors de ceux compliqués d’ECUN, la symptomatologie s’est amendée en moins de 10 jours (moyenne±SD=3,5±2,3 jours) après exclusion des protéines du LV. 63,6 % des enfants ont pu reprendre une alimentation normale à 1 an et 85 % à 2 ans.

L’expérience rapportée met en exergue l’importance de corréler les données anamnestiques, cliniques et endoscopiques dans le diagnostic des rectorragies du petit enfant. La colite au LV est, en effet, une entité assez bien définie dont l’évolution est favorable sous alimentation d’exclusion appropriée.

Summary

Rectal bleeding in neonatal period is not a rare event and should make the physician suspect necrotizing enterocolitis (NEC) and discuss cow’s milk (CM) protein induced colitis among other etiologies. The clinical and endoscopic findings from 33 newborn infants with acute demonstrated CM allergy colitis are detailed. All of them fulfilled indeed the ESPGAN’s diagnostic criteria for food allergy. 66.4 % of the reported patients had onset within the two first weeks of life. 12 of them were preterm babies among whom 7 were breast fed. Remarkable clinical associated features were diarrhea (60 %), vomiting (42.4 %), failure to thrive (30 %). Two preterm infants developed simultaneous NEC with subsequent short bowel syndrom in one case and colonic stricture in the other one. Mucosal alterations included erythema edema and exsudate in all cases. The mucosa was moreover friable in 15 cases and ulcerated in 8. Biopsies performed in only 7 infants showed various degrees of inflammation with crypt abcesses in 2 cases. Except for the NEC cases symptoms subsided within ten days (mean±SD=3.5±2.3 days) after milk elimination diet. 63.6 % of the children were able to drink milk at one year of age and 85 % at 2 years.

The experience reported emphasize the importance of correlating history and endoscopy when diagnosing causes of infant’s rectal bleeding. CM induced colitis is well defined clinically and histologically and resolved completely on an appropriate exclusion diet.

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Authors and Affiliations

  1. Services de Médecine Infantile, C.H.U. de Grenoble, Grenoble, France

    A. Joannard & M. Bost

  2. Service de Médecine Néonatale et Réanimation Infantile, C.H.U. de Grenoble, Grenoble, France

    P. Rambaud

  3. Unité de Nutrition et d’Explorations Fonctionnelles Digestives Pédiatriques, C.H.U. de Grenoble, F-38043, Grenoble Cedex

    J. P. Chouraqui & M. Barbier

Authors
  1. J. P. Chouraqui
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  2. M. Barbier
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  3. A. Joannard
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  4. P. Rambaud
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  5. M. Bost
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Chouraqui, J.P., Barbier, M., Joannard, A. et al. Colite néonatale par allergie aux protéines du lait de vache. Acta Endosc 24, 461–468 (1994). https://doi.org/10.1007/BF02968667

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  • DOI: https://doi.org/10.1007/BF02968667

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