Proctoscopic Observations in Gastrointestinal Allergy

Abstract

Introduction

Recent discussions concerning gastro-intestinal allergy prompted us to investigate methods whereby we might make direct observations of the character of the reaction produced when an allergen comes in contact with the mucosa of the gastro-intestinal tract. We were concerned not only with the local area involved but also with the symptom-complex resulting from such a reaction; namely, abdominal cramps, diarrhea, constipation, nausea and vomiting, pyrosis, etc. Four clinical methods of approach to this investigation were roentgenographic, gastroscopic, endoscopic through a fistula or in colostomy, and proctoscopic. The two case reports are concerned with the proctoscopic approach.

The two cases cited present findings typical of the proctoscopic approach to sensitization study. The technic entailed tap water enemas the night prior to examination. On the morning of examination, the procto-scope was introduced with a minimal amount of a non-irritating water soluble lubricant. The character of the rectal mucosa was noted and the rectal valves were identified as test sites. The allergens were applied in powdered form, using that amount which would adhere to the end of the cotton applicator. The tests were read in from five to twenty minutes, depending upon the rapidity of the reaction, and were graded from l+ to 4+, according to the amount of erythema, edema, engorgement of the vessels, and hemorrhage present. Any symptoms resulting from the test such as cramps or lower abdominal distress were recorded.

Case reports

Case 1: A thirty-five year old white woman who was first observed in July, 1939, complained of. . .