Inflammatory bowel disease in infancy: an increasing problem?

Seven children with intractable diarrhoea of infancy seen between 1990 and 1993 developed endoscopically established inflammatory bowel disease unrelated to bacterial infection and not responsive to whole protein exclusion. Mouth ulcers were present in two patients, endoscopic upper-gastrointestinal-tract inflammation in two, villous atrophy in six, and chronic nonspecific colitis in all seven. There was considerable clinical and histological heterogeneity. All patients required parenteral nutrition. Steroid therapy was completely successful in only one child, while two underwent colectomy, and two died. Previously described cases other than those due to infection or milk intolerance have been rare and sporadic. The prevalence of inflammatory bowel disease in infancy is unknown but appears to be increasing.