To investigate the incidence of cow’ s milk allergy as evidenced by milk challenge and the findings of endoscopic and immunohistochemical examinations in children with chronic and refractory constipation. Thirty-five...To investigate the incidence of cow’ s milk allergy as evidenced by milk challenge and the findings of endoscopic and immunohistochemical examinations in children with chronic and refractory constipation. Thirty-five study subjects (mean age, 8.3 ± 3.3 years; range, 3-15 years; 17 girls) and 15 control subjects (mean age, 11.7 ± 3.2 years; range, 2-15 years; 9 girls) were studied by colonoscopy and a 4-week cow’ s milk elimination and challenge. Lymphoid nodular hyperplasia was the most prominent endoscopic finding in half of the subjects (46% ), mostly occurring patchily in the transverse colon. Histologic findings other than lymphoid accumulation and mildly increased density of eosinophils were few. During the milk elimination and with supportive medication, 83% of subjects remitted. Constipation and/or other gastrointestinal or skin symptoms relapsed only in one third (34% ) during the cow’ s milk challenge, these having significantly higher densities of intraepithelial γ δ + T cells (P < .001) in the biopsy samples of the terminal ileum as compared with the control subjects. We were able to find formal evidence for the presence of cow’ s milk allergy in children with chronic constipation.展开更多
文摘To investigate the incidence of cow’ s milk allergy as evidenced by milk challenge and the findings of endoscopic and immunohistochemical examinations in children with chronic and refractory constipation. Thirty-five study subjects (mean age, 8.3 ± 3.3 years; range, 3-15 years; 17 girls) and 15 control subjects (mean age, 11.7 ± 3.2 years; range, 2-15 years; 9 girls) were studied by colonoscopy and a 4-week cow’ s milk elimination and challenge. Lymphoid nodular hyperplasia was the most prominent endoscopic finding in half of the subjects (46% ), mostly occurring patchily in the transverse colon. Histologic findings other than lymphoid accumulation and mildly increased density of eosinophils were few. During the milk elimination and with supportive medication, 83% of subjects remitted. Constipation and/or other gastrointestinal or skin symptoms relapsed only in one third (34% ) during the cow’ s milk challenge, these having significantly higher densities of intraepithelial γ δ + T cells (P < .001) in the biopsy samples of the terminal ileum as compared with the control subjects. We were able to find formal evidence for the presence of cow’ s milk allergy in children with chronic constipation.
