title: Histological findings in infants with Gastrointestinal food allergy are associated with specific gastrointestinal symptoms; retrospective review from a tertiary centre.
abstract: BACKGROUND
  Gastrointestinal food allergy (GIFA) occurs in 2 to 4 % of children, the majority of whom are infants (<1 year of age). Although endoscopy is considered the gold standard for diagnosing GIFA, it is invasive and requires general anaesthesia. Therefore, we aimed to investigate whether in infants with GIFA, gastrointestinal symptoms predict histological findings in order to help optimise the care pathway for such patients.
  
  
  METHODS
  All infants <1 year of age over a 20 year period who underwent an endoscopic procedure gastroscopy or colonoscopy for GIFA were evaluated for the study. Symptoms at presentation were reviewed and compared with mucosal biopsy histological findings, which were initially broadly classified for study purposes as "Normal" or "Abnormal" (defined as the presence of any mucosal inflammation by the reporting pathologist at the time of biopsy).
  
  
  RESULTS
  Of a total of 1319 cases, 544 fitted the inclusion criteria. 62 % of mucosal biopsy series in this group were reported as abnormal. Infants presenting with diarrhoea, rectal (PR) bleeding, irritability and urticaria in any combination had a probability >85 % (OR > 5.67) of having abnormal histological findings compared to those without. Those with isolated PR bleeding or diarrhoea were associated with 74 % and 68 % probability (OR: 2.85 and 2.13) of an abnormal biopsy, respectively. Conversely, children presenting with faltering growth or reflux/vomiting showed any abnormal mucosal histology in only 50.8 % and 45.3 % (OR: 1.04 and 0.82) respectively.
  
  
  CONCLUSIONS
  Food allergy may occur in very young children and is difficult to diagnose. Since endoscopy in infants has significant risks, stratification of decision-making may be aided by symptoms. At least one mucosal biopsy demonstrated an abnormal finding in around half of cases in this selected population. Infants presenting with diarrhoea, PR bleeding, urticaria and irritability are most likely to demonstrate abnormal histological findings.
authors.affiliation: Paediatric Gastroenterology Department, Great Ormond Street Hospital, London, WC1N 3JH United Kingdom.|Institute of Child Health/UCL, London, WC1N 1EH UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Shah
authors.affiliation: Paediatric Gastroenterology Department, Great Ormond Street Hospital, London, WC1N 3JH United Kingdom.
authors.forename: Ru-Xin Melanie
authors.initials: RM
authors.lastname: Foong
authors.affiliation: Paediatric Gastroenterology Department, Great Ormond Street Hospital, London, WC1N 3JH United Kingdom.
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Borrelli
authors.affiliation: Paediatric Gastroenterology Department, Great Ormond Street Hospital, London, WC1N 3JH United Kingdom.
authors.forename: Eleni
authors.initials: E
authors.lastname: Volonaki
authors.affiliation: Paediatric Gastroenterology Department, Great Ormond Street Hospital, London, WC1N 3JH United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Dziubak
authors.affiliation: Paediatric Gastroenterology Department, Great Ormond Street Hospital, London, WC1N 3JH United Kingdom.
authors.forename: Rosan
authors.initials: R
authors.lastname: Meyer
authors.affiliation: Paediatric Gastroenterology Department, Great Ormond Street Hospital, London, WC1N 3JH United Kingdom.
authors.forename: Mamoun
authors.initials: M
authors.lastname: Elawad
authors.affiliation: Histopathology Department, Great Ormond Street Hospital, London, United Kingdom.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Sebire
keywords: Biopsy; Endoscopy; Eosinophil; Food allergy; Histopathology; Infant