Specific Therapies

1. Treatment is directed at underlying problem. Allergic colitis is managed with hydrolyzed formula. Necrotizing enterocolitis is managed with supportive care. Appropriate antibiotics, most notably metronidazole, are used in treatment of C difficile colitis. Immunosuppressive agents are used in management of inflammatory bowel disease; they have also been successful in patients with rapidly proliferating hemangiomas.

2. Endoscopic Therapy. Most common indication for this therapy is polypectomy; it is also used for sclerotherapy, electrocautery, and elastic band ligation.

3. Surgery. Reserved for nonreducible intussusception, vascular anomaly, and structural lesions.

VI. Problem Case Diagnosis. The 1-month-old patient appeared well, with normal vital signs. Parents described streaks of bright red blood on formed stool with each diaper change. Child was consuming cow's milk formula without any evidence of intolerance or emesis. Physical exam was completely benign. Presence of blood was confirmed with guaiac test. CBC was normal, but stool was positive for eosinophils. Diagnosis is allergic colitis; a hydrolyzed formula is recommended.

VII. Teaching Pearl: Question. What is the most common cause of lower GI bleeding in children younger than 1 year of age compared with those older than 1 year?

VIII. Teaching Pearl: Answer. Allergic colitis and anorectal fissure are frequent diagnoses in children younger than 1 year of age. Infectious gastroenteritis and anorectal fissures are common diagnoses in children older than 1 year. Painless rectal bleeding is more common with vascular malformation, polyp, or Meckel diverticulum. Painful rectal bleeding is seen with infectious, inflammatory, or ischemic lesions. Inflammatory bowel disease is rarely diagnosed before the age of 5 years.

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