|
|
 | |||||||||||||||||||||||||||||||||||||||||||||||
 | |||||||||||||||||||||||||||||||||||||||||||||||
| |||||||||||||||||||||||||||||||||||||||||||||||
Background Chronic diarrhea is the most common gastrointestinal symptom of intolerance of cow's milk among children. On the basis of a prior open study, we hypothesized that intolerance of cow's milk can also cause severe perianal lesions with pain on defecation and consequent constipation in young children.
Methods We performed a double-blind, crossover study comparing cow's milk with soy milk in 65 children (age range, 11 to 72 months) with chronic constipation (defined as having one bowel movement every 3 to 15 days). All had been referred to a pediatric gastroenterology clinic and had previously been treated with laxatives without success; 49 had anal fissures and perianal erythema or edema. After 15 days of observation, the patients received cow's milk or soy milk for 2 weeks. After a one-week washout period, the feedings were reversed. A response was defined as eight or more bowel movements during a treatment period.
Results Forty-four of the 65 children (68 percent) had a response while receiving soy milk. Anal fissures and pain with defecation resolved. None of the children who received cow's milk had a response. In all 44 children with a response, the response was confirmed with a double-blind challenge with cow's milk. Children with a response had a higher frequency of coexistent rhinitis, dermatitis, or bronchospasm than those with no response (11 of 44 children vs. 1 of 21, P=0.05); they were also more likely to have anal fissures and erythema or edema at base line (40 of 44 vs. 9 of 21, P<0.001), evidence of inflammation of the rectal mucosa on biopsy (26 of 44 vs. 5 of 21, P=0.008), and signs of hypersensitivity, such as specific IgE antibodies to cow's-milk antigens (31 of 44 vs. 4 of 21, P<0.001).
Conclusions In young children, chronic constipation can be a manifestation of intolerance of cow's milk.
Source Information
From the Divisione di Pediatria, Ospedale G. Di Cristina (G.I., F.C., M.T.), and the Cattedra di Medicina Interna (G.M., M.S., A.N., A.C.) and Istituto di Anatomia Patologica (A.F.), Università di Palermo — all in Palermo, Italy.
Address reprint requests to Dr. Carroccio at Via A. Coffaro 25, 90124 Palermo, Italy.
Related Letters:
Cow's Milk and Chronic Constipation in Children
Eigenmann P. A., Zamora S. A., Belli D. C., Daher S., Solé D., de Morais M. B., Shah N., Lindley K., Milla P., Carroccio A., Cavataio F., Iacono G.
Extract |
Full Text
N Engl J Med 1999;
340:891-892, Mar 18, 1999.
Correspondence
This article has been cited by other articles:
HOME | SUBSCRIBE | SEARCH | CURRENT ISSUE | PAST ISSUES | COLLECTIONS | PRIVACY | HELP | beta.nejm.org Comments and questions? Please contact us. The New England Journal of Medicine is owned, published, and copyrighted © 2008 Massachusetts Medical Society. All rights reserved. |
Previous
