title: Allergic gastroenteropathy in preterm infants.
abstract: OBJECTIVE
  To determine the clinical presentation, histopathologic features, and outcome of biopsy-proven allergic gastroenteropathy (AGE) in preterm infants. We hypothesized that AGE is a more frequent cause of gastrointestinal disease in this population than previously suspected.
  
  
  METHODS
  The retrospective portion of the study, from 1992 to 1997, included preterm infants <37 weeks' gestation who underwent biopsy because of suspected AGE. The prospective portion, from January to December 1998, included 20 infants undergoing endoscopy and biopsy because of suspected AGE.
  
  
  RESULTS
  Twenty-five infants (12 retrospective/13 prospective) with mean gestational age of 29 weeks at birth and mean postnatal age at diagnosis of 78 days were diagnosed with AGE. Three clinical patterns of presentation were noted: group 1, gastroesophageal reflux disease (n = 5); group 2, non-specific feeding intolerance (n = 8); and group 3, lower gastrointestinal bleeding (n = 12). Ten patients had negative biopsy findings (3 retrospective/7 prospective) and had clinical features indistinguishable from those of groups 1 and 2. Patients in group 3 were most likely to have positive biopsy findings (12 of 12). Fifteen patients responded to a casein hydrolysate formula, and 10 patients required an amino acid-based formula. Patients with AGE who had eosinophilic infiltration and villous atrophy took longer to recover than those with eosinophilic infiltration alone (P <.03). Subsequently, most have tolerated formula challenges and are currently tolerating cow's milk.
  
  
  CONCLUSIONS
  AGE may be an under-recognized cause of gastrointestinal symptoms in preterm infants. Confirmation with endoscopy and biopsy can be done safely and provides the basis for appropriate dietary management.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT 06106, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: D'Netto
authors.forename: V C
authors.initials: VC
authors.lastname: Herson
authors.forename: N
authors.initials: N
authors.lastname: Hussain
authors.forename: A
authors.initials: A
authors.lastname: Ricci
authors.forename: R T
authors.initials: RT
authors.lastname: Brown
authors.forename: J S
authors.initials: JS
authors.lastname: Hyams
authors.forename: C J
authors.initials: CJ
authors.lastname: Justinich
mesh_terms: D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000276:immunology* / Q000628:therapy; D006801:Humans; D006967:Hypersensitivity / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D011446:Prospective Studies; D012189:Retrospective Studies