Stanford School of Medicine
Surgical Pathology Criteria
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Food Enteropathy

Definition

  • Enteropathy caused by sensitivity to foods such as cow milk protein

Alternate/Historical Names

  • Allergic gastroenteropathy
  • Cow milk protein enteropathy

Diagnostic Criteria

  • Presents under 12 months of age or on exposure to the food in question
  • Biopsy of esophagus may show marked eosinophilic infiltrate
  • Biopsy of small intestine is non-specific
    • Acute and chronic inflammation
    • Variable numbers of eosinophils
    • Variable villous atrophy
    • Intra-epithelial lymphocytes may be increased by usually fewer than in celiac disease
  • Diagnosis based on resolution following dietary restriction
    • Cow milk is a common cause
    • Breast milk and soy protein may also be causes
    • Others include egg and wheat

Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting : November 11, 2009

Differential Diagnosis

 

Food Protein Enteropathy Autoimmune Enteropathy
Predominantly eosinophilic infiltrate Predominantly T cell infiltrate
Frequent associated allergy or atopy No association with other allergies or atopy
Resolved by elimination of offending food from diet Not related to diet
For pediatric autoimmune enteropathy with associated polyendocrinopathy see IPEX syndrome.

 

Food Protein Enteropathy Common Variable Immunodeficiency – GI Involvement
Numerous plasma cells Plasma cells frequently markedly decreased
Predominantly eosinophilic infiltrate Nodular lymphoid hyperplasia
Frequent associated allergy or atopy No association with other allergies or atopy
Resolved by elimination of offending food from diet Not related to diet

Bibliography

  • Noffsinger A, Fenoglio-Preiser CM, Maru D, Gilinisky N.  Gastrointestinal Diseases, AFIP Atlas of Nontumor Pathology, First Series, Fascicle 5, 2007
  • Sampson HA, Anderson JA. Summary and recommendations: Classification of gastrointestinal manifestations due to immunologic reactions to foods in infants and young children. J Pediatr Gastroenterol Nutr. 2000;30 Suppl:S87-94.
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