Sir.—In the March 1989 issue of AJDC Berezin et al1 stated that "colonoscopy is the most effective means of establishing a definitive diagnosis" of milk intolerance of infancy. They implied a diagnosis protocol for hematochezia consisting of colonoscopy with multiple biopsy procedures, treatment with protein hydrolysate formula, and repeated colonoscopy in 2 weeks. They cautioned that "histologic findings may be similar in other disease states [but] rapid resolution and reappearance of colonic abnormalities after withdrawal and rechallenge... clearly establish a clinical diagnosis of protein intolerance." This would require four colonoscopies and at least two biopsies.
The cost of a colonoscopsy is about $500, and a biopsy with pathologic diagnosis adds up to $700. Using the protocol implied by Berezin et al, this would cost the patient between $1200 and $4800. This cost does not include office visits to a specialist, laboratory evaluations, or incidental costs due to time