Chronic constipation as a symptom of cow milk allergy

doi:10.1016/S0022-3476(95)70496-5

The Journal of Pediatrics

Volume 126, Issue 1, January 1995, Pages 34-39

https://doi.org/10.1016/S0022-3476(95)70496-5 Get rights and content

Abstract

Twenty-seven consecutive infants (mean age, 20.6 months) with chronic “idiopathic” constipation were studied to investigate the possible relation between constipation and cow milk protein allergy (CMPA). The infants were initially observed on an unrestricted diet, and the number of stools per day was recorded. Subsequently the infants were put on a diet free of cow milk protein (CMP) for two periods of 1 month each, separated by two challenges with CMP. During the CMP-free diet, there was a resolution of symptoms in 21 patients; during the two consecutive challenges, constipation reappeared within 48 to 72 hours. In another six patients the CMP-free diet did not lead to improvement of constipation. Only four of the patients who improved on the CMP-free diet had concomitant symptoms of suspected CMPA, but a medical history of CMPA was found in 15 of the 21 patients cured and in only one of the six patients whose condition had not improved (p < 0.05); in addition, in 15 of the 21 cured patients, results of one or more laboratory tests (specific IgE, IgG, anti-β-lactoglobulin, circulating eosinophils) were positive at the time of diagnosis, indicating hypersensitivity, compared with one of the six patients whose condition did not improve (p< 0.05). The endoscopic and histologic findings at the time of diagnosis showed proctitis with monocytic infiltration in two patients cured with the CMP-free diet; after 1 month on this diet, they were completely normal. We conclude that con stipation in infants may have an allergic pathogenesis. (J PEDIATR 1995;126:34-9)

Section snippets

METHODS

The study group included all the patients with chronic constipation, aged < 3 years, referred to our pediatric gastroenterology clinic during the preceding 12 months. Two patients with mental retardation and one with Hirschsprung disease were excluded. Anorectal manometry and biopsy of the intestinal mucosa were also performed in two cases of suspected megacolon and megarectum (patients with marked abdominal distention and clinical signs of malnutrition). Twenty-seven infants (15 boys) were

RESULTS

During the first month of the CMP-free diet there was a significant improvement in symptoms in 21 patients: the frequency of stools significantly increased, feces were soft, and none of the infants had any discomfort when passing stools. These improvements were rapid; in all patients the bowel frequency became normal within the first 3 days of the CMP-free diet. In the remaining six study patients, the CMP-free diet did not lead to any changes, either in the number of stools or in the symptoms

DISCUSSION

These data indicate that some cases of “idiopathic” constipation were due to CMPA; 21 of 27 of the patients showed rapid improvement. Symptoms completely regressed when a CMP-free diet was used, and there was a clinical relapse during two subsequent cow milk challenges. The possibility that CMPA might be manifested only by the presence of constipation has rarely been reported; 8, 9 apart from single case reports, the presence of constipation as a symptom of CMPA has been reported only in

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However, the pathogenesis of CM-intolerance-related constipation is unknown and the existence of an inflammatory condition is still debated. Between December, 2012 and January, 2014 we conducted a new study to evaluate the histological characteristics of patients with chronic constipation due to CM-intolerance [4,5]. The study included a consecutive series of patients suffering from chronic constipation who were unresponsive to a previous standard treatment.
Allergic proctitis can occur in infants and children. It is expressed by feces streaked with blood without other apparent signs. More than 50% of these patients are being breast-fed. Recently, it has been found that a particular symptom of allergic proctitis is constipation, and it is a major cause of consultations in pediatric gastroenterology departments. We carried out a study, which included a series of patients who were seen for chronic constipation that had not responded to the usual therapy. We found that the majority of these patients had a reduction in the layer of mucus coating the rectum, and this sign was associated with intolerance to cow's milk protein and also to other foods. In patients suffering from chronic constipation associated with proctitis due to food intolerance, reduction in the rectal mucus coating can be considered to be one of the characteristic factors in the pathogenesis of the patient's constipation.
Des proctites allergiques peuvent se produire chez les enfants et les nourrissons. Elles s’expriment par des selles striées de sang sans autres signes apparents. Plus de 50 % des patients sont allaités au sein. Récemment, il a été montré qu’un symptôme particulier de la proctite allergique était la constipation, qui est une cause majeure de l’accès aux soins ambulatoires en gastro-entérologie pédiatrique. Nous avons réalisé une étude concernant une série de patients adressés pour constipation chronique ne répondant pas au traitement habituel et nous avons mis en évidence chez la plupart d’entre eux une réduction de la couche de mucus de la région rectale reliée à une intolérance aux protéines du lait de vache. Les principales conclusions de notre étude étaient que la constipation chronique chez les enfants pouvait être due à une intolérance aux protéines du lait de vache et à des intolérances alimentaires. Chez les patients souffrant de constipation chronique secondaire à une proctite par intolérance alimentaire, la réduction de la couche de mucus rectal peut être considérée comme l’un des facteurs déterminants dans la pathogenèse de la constipation.
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Chronic constipation as a symptom of cow milk allergy☆,☆☆,★

Abstract

Section snippets

METHODS

RESULTS

DISCUSSION

Gastroenterology

J P EDIATR

J PEDIATR

Lancet

J PEDIATR

Chronic constipation in childhood: a longitudinal study of 186 patients

J Pediatr Gastroenterol Nutr

Encopresis: a review of thirty-two cases

Acta Pediatr Scand

Constipation terminale par asychronisme abdomino-pelvien: analyse des donnees etiologiques, cliniques, manometriques, et des resultats therapeutiques apres rééducation par biofeedback

Gastroenterol Clin Biol

Effect of Cisapride on chronic idiopathic constipation in children

Dig Dis Sci

Allergy to cow's milk presenting as a chronic constipation

BMJ