Food related enteropathies

What are food related enteropathies?

A reaction to food may or may not be immunological in nature (implying involvement of the immune system). In lactose intolerance, the immune system is not implicated; the symptoms are caused by the absence of an enzyyme used to digest a sugar present in milk and milk products.

An immunological reaction to food may or may not involve IgE antibodies. When these are present, you may have a "classical" food allergy, including symptoms of hives, swelling, vomiting, difficulty breathing.

Certain immunological food reactions do not involve IgE antibodies, and are associated mostly with gastrointestinal symptoms (vomiting, abdominal pain, diarrhea). These disorders are sometimes associated with the presence of eosinophils (a type of white blood cell) and are discussed in the section on eosinophilic esophagitis.

In this section, we discuss the reactions known as food related enteropathies, that is to say, immunological reactions to foods that occur within the digestive system. This group includes 1) proctitis/proctocolitis induced by food proteins, 2) enteropathy induced by food proteins, 3) the syndrome of enterocolitis induced by food proteins.

What are the symptoms and the causes?

1. Proctitis/proctocolitis induced by food proteins

Bleeding is noted in the stools of babies only several weeks old and who are otherwise in good health. Intestinal irritation is often caused by cow's milk proteins (and occasionally soy) found in maternal milk or in milk formulas.

2. Enteropathy induced by food proteins

Chronic diarrhea, vomiting, growth delay, and anemia cause by food proteins, mostly cow's milk. This disease is often treated in collaboration with gastroenterologists (specialists in intestinal disorders). Celiac disease is part of this group. These affected patients are sensible to gluten contained in wheat, barley, rye and sometimes oats. This disease may occur in the infant or in the adult.

3. The syndrome of enterocolitis induced by food proteins

Profound vomiting and sometimes diarrhea occurs on average 2 hours after ingesting a food, especially in infants. The infant often looks very sick and dehydrated. The causes include cow's milk, but also soy, cereals (rice, oats, barley), meats, fruits and vegetables, fish, other seafood, and legumes.

How does one diagnose a food related enteropathy?

The diagnosis is usually made by history. The symptoms are sometimes confounded with other symptoms of colic and gastroesophageal reflux in the baby. Allergy skin tests don't detect this type of food reaction.

What is the treatment?

In the case of a reaction to cow's milk protein, if the symptoms are present while the mother is breast feeding, then elimination of these proucts from the mother's diet may be tried. If this is done, then careful attention must be paid to calcium and vitamin D supplementation. Another possibility is to place the baby on a hydrolysed milk formula (a milk-based formula in which the proteins have been broken down and don't cause a reaction; example : Nutramigen™, Alimentum™), or in more severe cases, a formula based on amino acids (example: Neocate™). If other foods are involved, dietary elimination is necessary.

After such interventions, improvement is noted in several days.

How do food related enteropathies evolve?

In the majority of infants, symptoms of proctocolitis disappear by the age of one year. It may take more time for resolution in children affected by an entercolitis caused by food proteins. Sometimes, reintroduction of the food must be performed under medical supervision, especially in the case of an enterocolitis induced by food proteins. Be sure to discuss this with your allergist.

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Nha Uyen Nguyen-Luu, MD FRCPC (translation: Andrew Moore, MD FRCPC)