Complications of Untreated Allergic Proctocolitis
Untreated allergic proctocolitis can lead to serious complications including persistent rectal bleeding, malnutrition, growth failure in infants, and progression to more severe inflammatory conditions affecting the entire colon. 1, 2
Understanding Allergic Proctocolitis
Allergic proctocolitis is an inflammation of the rectum and distal colon typically caused by food protein allergies, distinct from infectious proctitis which is often sexually transmitted. Key characteristics include:
- Inflammation limited to the rectum and distal colon, with symptoms including rectal bleeding, mucous discharge, and occasional tenesmus 2, 3
- In infants, commonly triggered by cow's milk or soy protein, even through breast milk 3
- In adults, can be triggered by specific food allergens or may overlap with inflammatory bowel disease 2, 3
Potential Complications of Untreated Disease
Short-term Complications
- Persistent rectal bleeding leading to iron deficiency anemia 3
- Tenesmus (painful, ineffective straining) causing significant discomfort 3, 4
- Diarrhea or constipation affecting quality of life 3
- Rectal pain and discomfort during defecation 2, 3
Medium-term Complications
- Malnutrition due to dietary restrictions or malabsorption 3
- In infants: failure to thrive and developmental delays 3
- Chronic inflammation leading to rectal ulceration 2, 3
Long-term Complications
- Progression from proctitis to more extensive colonic involvement 3
- Potential development of strictures in chronic cases 3
- Increased risk of misdiagnosis as inflammatory bowel disease, leading to inappropriate treatment 2, 5
Diagnostic Considerations
Proper diagnosis is essential to prevent complications from untreated disease:
- Endoscopic evaluation with biopsy is the gold standard for diagnosis 3
- Characteristic findings include eosinophilic infiltration of the lamina propria 3
- Elimination diets and food challenge tests may help identify specific allergens 3
- Important to distinguish from infectious proctitis, which requires different treatment 2, 5
Treatment Approach
Early treatment is crucial to prevent complications:
- Elimination of triggering allergens is the primary treatment 3
- In infants, may require switching to extensively hydrolyzed or amino acid-based formulas 3
- Topical anti-inflammatory agents may be needed in more severe cases 3
- Regular follow-up to monitor response to treatment and adjust as needed 3
Special Considerations
- In infants, most cases resolve by 1-2 years of age with appropriate dietary management 3
- In adults, may be more persistent and require longer-term management 2, 3
- Differential diagnosis must include infectious causes of proctitis, especially in sexually active adults 2, 5, 4
- Untreated cases may be mistaken for inflammatory bowel disease, leading to inappropriate immunosuppressive therapy 2, 5