Colonic lymphoid nodular hyperplasia in children: relationship to food hypersensitivity

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1. Clin Gastroenterol Hepatol. 2007 Mar;5(3):361-6.

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Colonic lymphoid nodular hyperplasia in children: relationship to food

hypersensitivity*.

Iacono G, Ravelli A, Di Prima L, Scalici C, Bolognini S, Chiappa S,

Pirrone G, Licastri G, Carroccio A.

Division of Pediatric Gastroenterology, Di Cristina Children's Hospital,

Palermo, Italy.

BACKGROUND & AIMS: The clinical significance of lymphoid nodular

hyperplasia (LNH) of the lower gastrointestinal tract is unclear. The

aim of this study was to define the frequency and clinical significance

of LNH in pediatric patients undergoing colonoscopy. METHODS: Two

hundred forty-five children (101 male, 144 female; median age, 8.5

years) for whom colonoscopy had been indicated were evaluated during a

3-year period. Apart from ileocolonoscopy with biopsy, all patients

underwent routine biochemistry, serum total and specific IgE, and/or

skin prick tests for food allergens. Patients with LNH underwent

elimination diet and subsequent food challenges. RESULTS: LNH was

observed in 73 of 245 (30%) consecutive colonoscopies. LNH was the only

abnormal finding in 52 of the 73 cases (71%). In 43 of these 52 patients

a diagnosis of cow's milk or multiple food hypersensitivity was made.

Food allergy was significantly more common than in patients without LNH

(83% vs 31%; P < .0001). The patients with LNH and food hypersensitivity

presented hematochezia (P < .0001), elevated serum

anti-beta-lactoglobulin IgG (P < .0001), anemia (P < .005), and failure

to thrive (P < .03) more frequently than those without LNH. In the LNH

patients histologic examination showed a higher number of lymphoid

follicles throughout the colon and the terminal ileum and an increased

number of lamina propria and intraepithelial eosinophils. CONCLUSIONS:

The presence of LNH in the colon and/or terminal ileum is a frequent

finding in symptomatic children undergoing colonoscopy. Unless

associated with other specific endoscopic or histologic lesions, LNH is

related to a condition of delayed-type food hypersensitivity.

PMID: 17368236

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2: Endoscopy. 1999 Aug;31(6):464-7.

Comment in: Endoscopy. 2000 Dec;32(12):1006-7.

*Lymphonodular hyperplasia on the duodenal bulb indicates food allergy

in children*.

Kokkonen J.

Dept. of Pediatrics, University of Oulu, Finland. jorma.kokkonen@...

BACKGROUND AND STUDY AIMS: Recently, lymphonodular hyperplasia (LNH)

of the duodenal mucosa has been described in association with

gastrointestinal food allergy. This study was designed to assess the

significance of LNH and other mucosal lesions of the foregut in

diagnosing food allergy and distinguishing it from other clinical

pathological states. PATIENTS AND METHODS: During a one-year period, 136

diagnostic esophagogastroduodenoscopies were conducted in children, 34

of whom had been diagnosed as having food allergy using an oral

challenge test. The endoscopic findings were analyzed in the final

diagnostic groups. RESULTS: LNH of the duodenal bulb with a normal

villous pattern was the main endoscopic finding in 22 of the 34 children

with food allergy (65 %). On the other hand, it was seen in none of the

18 patients with celiac disease, who had an atrophic duodenal mucosa.

All 11 patients with Helicobacter pylori infection had lymphonodular

gastritis, but no LNH beyond the pylorus. Esophagitis (six patients) and

gastritis (eight patients) were also common endoscopic findings

associated with food allergy. CONCLUSION: LNH in the duodenal bulb was

associated mainly with food allergy in children. An endoscopic

examination can be used as a new method of assessing gastrointestinal

food allergy and differentiating it from celiac disease and other

distinct types of gastrointestinal pathology.

PMID: 10494687