Objective. Chronic constipation in children can be linked to cow’ s milk int olerance (CMI) but the existence of a food intolerance- dependent proctitis is still debated. The aim of this study was to evaluate the his...Objective. Chronic constipation in children can be linked to cow’ s milk int olerance (CMI) but the existence of a food intolerance- dependent proctitis is still debated. The aim of this study was to evaluate the histologic data in patients with food intolera nce- related constipation. Material and methods. Fifty- two consecutive patien ts (22 M, median age 4 years) with chronic constipation unresponsive to common t reatment were enrolled. All patients were put on a cow’ s milk- free diet for 4 weeks and those uncured on this diet underwent a subsequent 4- week period of oligoantigenic diet. In the patients cured on elimination diet, a subsequent do uble- blind food challenge was performed to confirm the diagnosis of food intol erance. At entry to the study, routine hemato- chemical and immunologic assays, rectoscopy, and histologic study of the rectal mucosa were performed. In the pa tients cured on elimination diet, rectal histology was repeated when they were c ured. Results. Twenty- four patients were found to be suffering from CMI and 6 from multiple food intolerance. These patients had a normal stool frequency on e limination diet, while constipation reappeared on food challenge. The condition of the remaining 22 patients did not improve on elimination diet. The patients w ith food intolerance showed a significantly higher frequency of erosions of the mucosa, number of intraepithelial lymphocytes and eosinophils, and number of eos inophils in the lamina propria. Study of the rectal mucus gel layer showed that the food- intolerant patients had a significantly lower thickness than the othe r subjects studied. In the food intolerant patients, histologic abnormalities di sappeared on elimination diet, when the patients were well. Conclusions. Food in tolerance- related constipation is characterized by proctitis with eosinophil i nfiltrate of the rectal mucosa. A reduced mucus gel layer can be considered a co ntributory factor in the pathogenesis of the constipation.展开更多
文摘Objective. Chronic constipation in children can be linked to cow’ s milk int olerance (CMI) but the existence of a food intolerance- dependent proctitis is still debated. The aim of this study was to evaluate the histologic data in patients with food intolera nce- related constipation. Material and methods. Fifty- two consecutive patien ts (22 M, median age 4 years) with chronic constipation unresponsive to common t reatment were enrolled. All patients were put on a cow’ s milk- free diet for 4 weeks and those uncured on this diet underwent a subsequent 4- week period of oligoantigenic diet. In the patients cured on elimination diet, a subsequent do uble- blind food challenge was performed to confirm the diagnosis of food intol erance. At entry to the study, routine hemato- chemical and immunologic assays, rectoscopy, and histologic study of the rectal mucosa were performed. In the pa tients cured on elimination diet, rectal histology was repeated when they were c ured. Results. Twenty- four patients were found to be suffering from CMI and 6 from multiple food intolerance. These patients had a normal stool frequency on e limination diet, while constipation reappeared on food challenge. The condition of the remaining 22 patients did not improve on elimination diet. The patients w ith food intolerance showed a significantly higher frequency of erosions of the mucosa, number of intraepithelial lymphocytes and eosinophils, and number of eos inophils in the lamina propria. Study of the rectal mucus gel layer showed that the food- intolerant patients had a significantly lower thickness than the othe r subjects studied. In the food intolerant patients, histologic abnormalities di sappeared on elimination diet, when the patients were well. Conclusions. Food in tolerance- related constipation is characterized by proctitis with eosinophil i nfiltrate of the rectal mucosa. A reduced mucus gel layer can be considered a co ntributory factor in the pathogenesis of the constipation.
