DIFFERENTIAL DIAGNOSTIC APPROACHES AND THERAPEUTIC TACTICS FOR HEMATOCHEZIA IN YOUNG CHILDREN AT THE OUTPATIENT STAGE. LITERATURE REVIEW

Abstract

Introduction. The presence of blood in a child’s stool is an alarming symptom that may indicate a range of serious and potentially lifethreatening conditions. However, in most cases, hematochezia is caused by food protein-induced allergic proctocolitis (FPIAP). Over the past decade, numerous studies have been conducted to optimize the diagnostic process and management strategies for children presenting with hematochezia. Objective. To systematize current approaches to diagnosing and treating hematochezia in infants in outpatient pediatric care. Materials and Methods. A review of 60 sources (2017–2025) was conducted using PubMed, Google Scholar, and ScienceDirect databases. Results and Discussion. The appearance of blood in the stool requires careful differential diagnosis by outpatient practitioners in order to identify serious pathologies at an early stage. FPIAP is a benign, non-IgE-mediated food allergy, most commonly triggered by cow’s milk protein that typically occurs during the first weeks of life in otherwise healthy infants. FPIAP is a clinical diagnosis, as there are currently no reliable biomarkers for the disease. Additional diagnostic investigations are warranted only if other serious conditions are suspected. Management is based on eliminating the causative protein: strict maternal diet during breastfeeding or switching to extensively hydrolyzed, less often amino acid-based, formulas in formula-fed infants. The prognosis is favorable, with tolerance typically achieved by age 1–3 years. Conclusions. Hematochezia requires thorough differential diagnosis that considers all possible etiological factors. Recognizing FPIAP as the most likely cause of hematochezia in infants helps to avoid unnecessary investigations and hospitalizations. The role and optimal duration of dietary management in FPIAP remain debated, with current recommendations varying regarding the necessity and timing of allergen elimination.