RESOLUTION

OF STOOL BLOOD IN BREAST-

FED INFANTS WITH MATERNAL INGESTION OF
PANCREATIC ENZYMES
Repucci A.

Journal of Pediatric Gastroenterology & Nutrition . : p 500, October 1999.

Author Information

MetroHealth Medical Center & CWRU, Cleveland, Ohio

Abstract 43

Background: When visible/occult blood is found in stools of exclusively breast-

fed (EBF) infants, it is often due to cow-milk/soy protein-induced allergic colitis.
Elimination of antigens from the maternal diet usually leads to rapid resolution.
If blood persists despite further maternal dietary restrictions, physicians might
advise mothers to stop breast-feeding and substitute with hypo-/mon-allergenic
formula. Pancreatic enzymes have been used by some to treat eczema due to
food protein allergy. The protease component is postulated to break down
offending proteins rendering them less antigenic. Aim: To determine if persistent
stool blood in the EBF infant, despite careful maternal dietary restriction,
resolves by providing pancreatic enzymes to the mother. Methods: Four term
EBF infants (ages 1.5-3mos.) were evaluated for visible/occult stool blood
despite maternal dietary restriction of cow-milk/soy protein. No mother had
cracked/sore nipples. All infants had a positive atopic family history but no anal
fissure or stool pathogens were found. Further restriction of egg, wheat, fish,
nuts and peanuts (≥ two weeks) did not eliminate stool blood. Dietary
compliance was monitored by a dietitian. Due to irritability, GE reflux, diarrhea
and hematochezia, two infants had endoscopy revealing allergic colitis. Mothers
were then prescribed pancreatic enzymes (Pancrease MT 4®, USP Units: 4,000
lipase/12,000 amylase, 12,000 protease) two capsules with meals/one with
snacks. Stool blood was followed two to three times/week by guaiac
(Hemoccult®) testing. Results: In ¾ infants, stool blood resolved within a few
days of therapy. One mother required three capsules with meals/two with snacks
before stool blood resolved. No side-effects occurred due to therapy.
Conclusion: Maternal pancreatic enzyme therapy can be an alternative treatment
for EBF infants with stool blood when dietary restriction fails. It allows mother
to continue to breastfeeding and to reduce the risk of anemia.

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Section Description

POSTER THEME SYMPOSIA

Clinical Disorders

© 1999 by European Society for Pediatric Gastroenterology, Hepatology, and

Nutrition and North American Society for Pediatric Gastroenterology,