In infants with suspected food protein induced proctocolitis (sFPIP) only a minority of patients are finally diagnosed with the disease following diagnostic dietary intervention (DDI). There is a need for a pathophysiological explanation for the cause of hematochezia in the majority of sFPIP infants.
We prospectively recruited infants with sFPIP and healthy controls. Fecal samples were collected at inclusion, week 4 (end of DDI in sFPIP), and week 8. For 16S rRNA sequencing (515F/806R) we used Illumina MiSeq sequencing system. Amplicon sequence variants were generated using Qiime2 and DADA2. Qiime diversity alpha and beta group comparisons and linear discriminant analysis effect size analysis was performed. For shotgun metagenomic analysis on species level we used KneadData and MetaPhlAn2.
Fourteen sFPIP infants were compared to 55 healthy infants. At inclusion overall microbial composition of sFPIP infants differed significantly from controls (weighted UniFrac; Pairwise PERMANOVA, P = 0.002, pseudo- F = 5.008). On genus level healthy infant microbiota was significantly enriched with Bifidobacterium ( B ) compared to sFPIP patients (linear discriminant analysis [LDA] = 5.5, P < 0.001, 31.3% vs 12.1%). sFPIP stool was significantly enriched by Clostridium sensu stricto 1 over controls (LDA = 5.3, P = 0.003, 3.5% vs 18.3%). DDI caused a significant and sustained increase of Bifidobacterium (LDA = 5.4, P = 0.048, 27.9%) in sFPIP infants. Species level analysis revealed significant reduction of abundance of B longum in sFPIP patients, which after DDI was reversed by B. species other than B longum .
We revealed a gut microbiota dysbiosis phenomenon in sFPIP infants. DDI induces a microbiota composition comparable to that of healthy infants. In most sFPIP infants hematochezia might be triggered by a gut microbiota dysbiosis phenomenon.

Distal ulcerative colitis (UC) is responsible for distressing symptoms and reduces quality of life (QoL). Oral and topical formulations of 5-amino-salicylic acid are the first line therapy for mild to moderate distal UC.
Our aim was to evaluate the impact of mesalazine treatment for mild to moderate ulcerative proctitis and proctosigmoiditis on patient QoL.
Ninety-three patients with mild to moderate ulcerative proctitis and proctosigmoiditis, initiating a treatment with Pentasa, were prospectively included. The primary endpoint was the change from baseline to W8 in patient health-related QoL (HRQoL) as measured by the Short Inflammatory Bowel Disease Questionnaire (SIBDQ) total score.
More than 80% of patients were prescribed with a rectal formulation, either alone (47.9%) or with an oral formulation (35.1%), and 17.0% of patients were prescribed oral formulation alone. Mean SIBDQ score was improved at W8 in patients affected with mild and moderate disease ( P  < 0.001 versus baseline in both groups, as well as in patients who achieved clinical remission ( P  < 0.001). Patients who achieved clinical remission at W8 reached a mean change of +6.7 (±7.1), whereas those who did not achieve clinical remission had a mean change of +1.1 (±8.9). Seventy-five per cent of patients had an improvement of their disability index at W8. Fecal incontinence was also improved at W8.
HRQoL measuring with the SIBDQ is proportionally related to disease activity in patients with distal UC treated with mesalazine.

BACKGROUND: Food protein-induced allergic proctocolitis (FPIAP) is the most common non-IgE-mediated food allergy and it varies between 4% and 8% in infants. The aim of the study was to evaluate the potential association between FPIAP in infants and maternal daily consumption of homemade fermented foods (FFs) during pregnancy.
METHODS: Two hundred and seven infants were included in this case-control study, 106 with physician-diagnosed FPIAP (FPIAP group) and 101 age- and gender-matched healthy infants (control group), together with their mothers. The frequency and diversity of the 8 most consumed homemade FFs in traditional Turkish cuisine and daily maternal consumption of these during pregnancy were evaluated retrospectively using a structured questionnaire.
RESULTS: Rates of vaginal delivery, maternal smoking during pregnancy, educational status, and monthly household income were higher in the FPIAP group than the control group (p = 0.046, p = 0.014, p < 0.001, and p = 0.009, respectively). The 3 most common daily-consumed FFs during pregnancy were, in order, yogurt, cheese, and tarhana. The diversity of daily-consumed FFs during pregnancy (p = 0.004) and the consumption of the 3 most common FFs (p = 0.011) were lower in the FPIAP group than in the control group. Maternal smoking during pregnancy (odds ratio [OR]: 2.97, 95% confidence interval [CI]: 1.19-7.41, p = 0.019) and a higher maternal educational status (OR: 3.34, 95% CI: 1.63-6.84, p = 0.001) increased the risk of FPIAP at multivariate logistic regression, while the diversity of maternal FF consumption was protective against FPIAP (OR: 0.75, 95% CI: 0.58-0.96, p = 0.025).
CONCLUSIONS: Daily maternal consumption of yogurt, cheese, and tarhana during pregnancy was less common in FPIAP. The diversity of traditional Turkish homemade FFs may reduce the risk of FPIAP, whereas maternal smoking and a higher maternal educational status were associated with an increased risk of FPIAP.

The gold standard diagnostic procedure for food protein-induced proctocolitis (FPIP) requires flexible sigmoidoscopy (FS). To date there is no validated, noninvasive test to confirm FPIP diagnosis. Eosinophil-derived neurotoxin (EDN), a product of eosinophil (EOS) degranulation, has been shown to correlate with eosinophil infiltration in other tissues. Our objective was to compare EDN concentrations in rectal epithelial samples from infants with FPIP with those from a control population.
Children who underwent routine FS at Arnold Palmer Hospital for Children were enrolled in an IRB-approved, prospective, open-label pilot study between July 2017 and May 2019. We obtained rectal epithelial samples via: rectal swab, cytology brushing through FS, and rectal biopsy through FS. We then measured EDN levels in the samples and compared levels found in infants with FPIP against levels found in the control group. FPIP was defined as more than 60 EOS per 10 high-power fields (HPF) in rectal epithelial tissue obtained via rectosigmoid biopsy.
Twenty-four patients were enrolled. The control group (n = 13) included patients with normal histopathology (84% boys, mean age 19 months, SD 6 months) and the FPIP group (n = 11) included patients with FPIP confirmed via biopsy (45% boys, mean age 6.9 months, SD 9 months). EDN concentration was significantly higher in the FPIP group than in the control group, for 2 sampling methods: rectal biopsy (183.6 ± 114.6 vs 76.6 ± 71.0 μg/mL; P = 0.010) and rectal swab (66.2 ± 64.8 vs 20.4 ± 22.2 μg/mL; P = 0.025).
EDN concentrations measured from rectal swab and rectal biopsy samples is elevated and may be a useful tool to screen for FPIP in children.

The objective of this pilot study was to assess the fecal microbiome and different immunological parameters in infant feces and maternal milk from mother-infant pairs in which the infants were suffering from different gastrointestinal disorders (colic, non-IgE-mediated cow milk protein allergy (CMPA), and proctocolitis). A cohort of 30 mother-infant pairs, in which the infants were diagnosed with these gastrointestinal disorders or included as healthy controls, were recruited. Bacterial composition of infant feces and breast milk was determined by metataxonomic sequencing. Immunological compounds were quantified using multiplexed immunoassays. A higher abundance of Eggerthellaceae, Lachnospiraceae and Peptostreptococcaceae, and lower abundance of Bifidobacterium and higher abundance of Rothia were registered in fecal samples from the CMPA group. Eggerthellaceae was also significantly more abundant in milk samples of the CMPA group. There were no differences in the concentration of immunological compounds in infant fecal samples between the four groups. In contrast, differences were found in the concentration and/or frequency of compounds related to acquired immunity and granulocyte colony stimulating factor (GCSF) in breast milk samples. In conclusion, a few microbial signatures in feces may explain part of the difference between CMPA and other infants. In addition, some milk immunological signatures have been uncovered among the different conditions addressed in this pilot study.

Sexually transmitted infections (STIs) are a major problem worldwide. In addition, the spectrum of STIs is now expanding, including parasitic, bacterial, and viral infections. The study retrospectively describes the presence of enteric pathogens among 73 patients with gastrointestinal symptoms of enteritis and proctocolitis attending to an STI unit in Barcelona, Spain, between 2015 and 2016. Only patients investigated for intestinal parasitic infections were included in the study. Different diagnostic procedures were established for the detection of parasites, bacterial enteropathogens, and other STI agents. Entamoeba histolytica was the most prevalent pathogen in our cohort (20.5%), especially among individuals with proctocolitis. Contrarily, Giardia intestinalis was detected in 11.0% of patients, only associated with enteritis cases. Polymicrobial infections were common in our study (45.2%). Of note, 55.6% of shigellosis cases were coinfected with E. histolytica. The investigation highlights the importance of including parasites as differential gastrointestinal diagnosis, disregarding travel history, particularly among risk populations.

Anti TNF alpha treatments are wide spectrum therapies. Multiple side effects have been reported in recent years, particularly peripheral neuropathies. We report a case of axonal neuropathy occurring three months after starting treatment with Infliximab. Our study focused on a 60-year old female patient treated for therapy-resistant hemorrhagic rectocolitis, requiring treatment with infliximab. Three months later, the patient had sensory axonal neuropathy. Etiologic assessment remained negative and dose reduction was accompanied by an improvement in symptoms. The time between initiation of treatment with Infliximab and the onset of clinical manifestations as well as improvement after dose reduction advocate the responsibility of infliximab in the occurrence of sensory neuropathy. Its management is not standardized and should be discussed case by case.

OBJECTIVE: The rate of extension of proctitis in Western countries has been reported, but no data regarding long-term follow-up have been described for the Japanese population. Additionally, patients with long-standing or extensive ulcerative colitis have an increased risk for developing colorectal cancer. This study evaluated both the rate of extension of the disease and the development of neoplasia among patients with an initial diagnosis of ulcerative proctitis.
METHODS: We retrospectively investigated the medical charts of patients with proctitis from 1979 to 2014. The primary focus of this research was the extension of the inflammatory area. The secondary focus included risk factors for disease extension and the development of neoplasia.
RESULTS: Sixty-six patients satisfied the inclusion criteria. Proximal extension of the disease occurred in 34 patients: 19 patients had left-sided colitis and 15 had pancolitis. According to a multivariate analysis, disease extension was significantly higher in patients with disease onset before 25 years of age (P-value = 0.043). The cumulative rates of disease extension at 10 and 20 years were 33.8% and 52.2%, respectively. Three patients were diagnosed with dysplasia during follow-up, all of whom experienced disease extension before the development of dysplasia.
CONCLUSIONS: The rate of extension of ulcerative colitis in the Japanese population was comparable to that in Western countries. A younger age of disease onset was associated with disease extension. Extension of proctitis may be associated with an increased risk of colorectal cancer.

OBJECTIVE: Diversion proctocolitis (DPC) frequently develops in the colorectum after diversion of the fecal stream characterized by bleeding from the inflamed mucosa. Short-chain fatty acids (SCFA) are responsible for growth and differentiation of enterocytes. Adult series have reported variable response of DPC to luminal SCFA. There is dearth of studies in children. We aimed to study incidence, clinical, endoscopic, and histopathological characteristics of DPC and effect of SCFA in children.
METHODS: Prospectively clinical, endoscopic, and histopathological evaluation was done for DPC in children undergoing fecal diversion. Patient characteristics, type and duration of stoma, symptoms, endoscopy and biopsy findings, duration of treatment and response to SCFA, time of closure of stoma, and any associated gut anomaly were recorded.
RESULTS: Fifteen children completed the study. Anorectal malformation was the commonest indication for stoma. Sixty percent were symptomatic within 2-9 months, excessive mucous discharge being the commonest symptom. All had at least one positive endoscopic finding; erythema, edema, and exudates being the commonest findings. All DPCs improved clinically and endoscopically following SCFA. Histological resolution was seen in 78 %, while 22 % had persistent disease. Closure of stoma showed complete resolution of DPC.
CONCLUSIONS: DPC was common (87 %) following stoma formation in children with strong male preponderance (6.5:1). The commonest indication for stoma was anorectal malformation (67 %). Clinical, endoscopic, and histopathological changes appeared within 2-9 months with symptomatic DPC in 60 %. All patients (100 %) had at least one positive endoscopic finding, histopathological examination confirmed the diagnosis. SCFA led to symptomatic, endoscopic, and histopathological resolution of DPCs. Closure of stoma cured all the persistent DPCs.

OBJECTIVE: To study the clinical characteristics of hospitalized infants with allergic proctocolitis, and to provide a scientific basis for early diagnosis and effective treatment of allergic proctocolitis.
METHODS: The clinical data of 96 infants with allergic proctocolitis between September 2011 and March 2013 were reviewed retrospectively. Descriptive analysis was performed to assess the clinical characteristics of allergic proctocolitis.
RESULTS: The most common clinical manifestation was diarrhea in the 96 infants. The electronic colonoscopy results indicated that 40% of the infants had multiple small nodules, 26% showed focal erythema and brittle mucous membranes, 25% showed multiple superficial erosion, and 9% showed ulcers with surface exudates. The affected areas included the sigmoid colon (87%), rectum (24%), descending colon (13%), and transverse colon ascending colon and ileocecal junction (8%). Histopathologic examination showed eosinophilic infiltration of mucosal layers, the condition of which was mild to moderate in 89% and severe and extremely severe in 12% of the infants. To treat the allergic proctocolitis, mothers and infants were suggested to avoid allergenic foods; 43% of them continued breastfeeding, 45% switched to highly hydrolyzed protein formula, and 13% were prescribed amino acid-based elemental formula. All infants were in complete remission at discharge.
CONCLUSIONS: As the clinical manifestations of allergic proctocolitis in infants lack specificity, the electronic colonoscopy and mucosal histopathologic examination are helpful for early and differential diagnosis. The best treatment is to avoid allergenic foods. Formula-feeding infants should be prescribed highly hydrolyzed protein formula or amino acid-based elemental formula.