Original Article
Lactobacillus GG Improves Recovery in Infants with Blood in the Stools and Presumptive Allergic Colitis Compared with Extensively Hydrolyzed Formula Alone

https://doi.org/10.1016/j.jpeds.2009.09.012Get rights and content

Objectives

To determine the benefits of Lactobacillus rhamnosus GG (LGG) in an extensively hydrolyzed casein formula (EHCF) in improving hematochezia and fecal calprotectin over EHCF alone.

Study design

Fecal calprotectin was compared in 30 infants with hematochezia and 4 weeks after milk elimination with that of a healthy group. We also compared fecal calprotectin and hematochezia on 26 formula-fed infants randomly assigned to EHCF with LGG (Nutramigen LGG) (EHCF + LGG) or without (Nutramigen) (EHCF − LGG) and on 4 breastfed infants whose mothers eliminated dairy.

Results

Fecal calprotectin in those with hematochezia was significantly higher than in comparisons (mean ± SD 325.89 ± 152.31 vs 131.97 ± 37.98 μg/g stool, t = 6.79, P < .0001). At 4 weeks, fecal calprotectin decreased to 50% of baseline but was still significantly higher than in comparisons (157.5 ± 149.13 vs 93.72 ± 36.65 μg/g, P = .03). Fecal calprotectin mean decrease was significantly larger among EHCF + LGG compared with EHCF − LGG (−214.5 ± 107.93 vs −112.7 ± 105.27 μg/g, t = 2.43, P = .02). At 4 weeks, none of the EHCF + LGG had blood in stools, and 5/14 on EHCF − LGG did (P = .002).

Conclusion

Fecal calprotectin is elevated in infants with hematochezia and possible allergic colitis. EHCF + LGG resulted in significant improvement of hematochezia and fecal calprotectin compared with the EHCF alone.

Section snippets

Methods

Infants from 0 to 12 months of age, fed a casein-based routine formula or breast milk, with presumptive diagnosis of CMAC (see below) were enrolled in group A; group B (comparison group) included healthy infants of the same sex and age, matched for the type of feeding (formula or breast milk), recruited from the general population of a local pediatric practice. Exclusion criteria were as follows: infants with Hirschsprung's disease, any kind of malformation, history of intestinal

Results

Thirty infants in group A and 32 in group B were enrolled. Both groups were similar with respect to gestational age and anthropometric data at birth (not shown) and at the time of enrollment (Table I). Age ranged from 1 to 10 months. At enrollment, 26 infants in group A were being fed a casein-based formula, and 4 were exclusively breastfed. Eighteen infants in group B were fed a casein-based formula, and 14 were breastfed. As anthropometric data were not significantly different between formula

Discussion

In allergic enteritis/colitis the mucosal inflammatory process is most likely result of a reaction to dietary antigens, typically, cow's milk proteins.1, 2, 4, 17 The condition rapidly resolves after antigen exclusion, and a normal diet can usually be achieved by 1 year of age.18

Calprotectin is a calcium and zinc-binding protein that accounts for 60% of the cytosol proteins in neutrophils and is elevated in the presence of ongoing inflammation.19 There is an age-dependent variation in fecal

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    Supported in part with funds from USDA/Agricultural Research Service under Cooperative Agreement number 58-6250-6001. The contents of this publication do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organization imply endorsement by the U.S. Government. Mead Johnson Nutritionals supplied the blinded formula. The kits to analyze the stool samples for calprotectin were supplied by Eurospital. C.L. was a part-time employee of Mead Johnson Nutritionals while the study was planned and conducted. M.E.B. wrote the first draft of the manuscript, and no honorarium, grant, or other form of payment was given to anyone to produce the manuscript. The other authors declare no conflicts of interest.

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