The question was:

> Do you think there might be another food which is likely to be suspect in
> this case, or another reason for the blood in the baby's stool?

I'm assuming there are no cracked and bleeding nipples contributing to
blood in the stool (I have seen mother's blood remain red in transit
through the baby's gut). One of the specific research studies I worked
on in one of my jobs was exactly this - what is the differential
diagnosis for bloody stools in either BF or ABM-fed babies? The "easier"
diagnosis is milk-protein allergy; the more difficult diagnosis is
Inflammatory Bowel Disease (IBD). It is important to know the difference
because the treatment is very different with significantly different
ramifications. The study I worked on was trying to develop a protocol
for making the diagnosis without having to do a small bowel biopsy
(which is the current standard for diagnosis); but rather, to fast the
baby for 5 hours, feed a specific oral test solution (of sugars) and
measure what sugars come out in the urine. If all the sugars do not come
back, the brush border of the bowel is damaged/inflammed and the
diagnosis of IBD can be made with confidence and appropriate treatment
can begin (which would have nothing to do with the type of milk intake).
I'm sorry to say I have not followed up and do not know if the study is
published yet. I hope the docs have thought of IBD, but I didn't pick up
that they did either.

Katharine West, BSN, MPH
Sherman Oaks, CA