Intestinal microbiota and secretory immunoglobulin A in feces of exclusively breast-fed infants with blood-streaked stools

Episodes of blood‐streaked stools are not uncommon in exclusively breast‐fed infants under 6 months of age. Such bleeding is thought to be associated with food protein‐induced proctocolitis, however the pathomechanism remains unclear. The aim of this study was to investigate intestinal microbiota and secretory immunoglobulin A in the feces of exclusively breast‐fed infants with blood‐streaked stools. Fecal specimens from 15 full‐term infants with blood‐streaked stools and 15 breast‐fed healthy infants were studied and the results compared. All infants had been delivered vaginally and exclusively breast‐fed. The fecal microbiota were investigated by phylogenetic analysis combined with culture methods for some bacterial species, and feces were assessed for the presence of fecal secretory immunoglobulin A by enzyme‐linked immunosorbent assay. Phylogenetic cluster analysis revealed four major clusters of fecal bacteria, cluster A being found only in healthy infants. The Bacteroides fragilis group was observed more frequently in controls than in patients (P < 0.05). In the controls, the predominant species belonging to the Enterobacteriaceae group was Escherichia coli, whereas in the patients it was Klebsiella (P < 0.05). Concentrations of secretory immunoglobulin A were high in one third of the healthy controls. In conclusion, the pathomechanism of rectal bleeding in exclusively breast‐fed infants may be related to differences in the composition of their intestinal flora.