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Intolerance of cow's milk and chronic constipation in children.

Abstract

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 two 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.

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  • Authors+Show Affiliations

    ,

    Divisione di Pediatria, Ospedale G. Di Cristina, Palermo, Italy.

    , , , , , ,

    Source

    The New England journal of medicine 339:16 1998 Oct 15 pg 1100-4

    MeSH

    Animals
    Child, Preschool
    Chronic Disease
    Constipation
    Cross-Over Studies
    Double-Blind Method
    Eosinophils
    Female
    Fissure in Ano
    Humans
    Infant
    Infant Food
    Inflammation
    Male
    Milk
    Milk Hypersensitivity
    Rectum
    Soybeans

    Pub Type(s)

    Clinical Trial
    Journal Article
    Randomized Controlled Trial

    Language

    eng

    PubMed ID

    9770556

    Citation

    Iacono, G, et al. "Intolerance of Cow's Milk and Chronic Constipation in Children." The New England Journal of Medicine, vol. 339, no. 16, 1998, pp. 1100-4.
    Iacono G, Cavataio F, Montalto G, et al. Intolerance of cow's milk and chronic constipation in children. N Engl J Med. 1998;339(16):1100-4.
    Iacono, G., Cavataio, F., Montalto, G., Florena, A., Tumminello, M., Soresi, M., ... Carroccio, A. (1998). Intolerance of cow's milk and chronic constipation in children. The New England Journal of Medicine, 339(16), pp. 1100-4.
    Iacono G, et al. Intolerance of Cow's Milk and Chronic Constipation in Children. N Engl J Med. 1998 Oct 15;339(16):1100-4. PubMed PMID: 9770556.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Intolerance of cow's milk and chronic constipation in children. AU - Iacono,G, AU - Cavataio,F, AU - Montalto,G, AU - Florena,A, AU - Tumminello,M, AU - Soresi,M, AU - Notarbartolo,A, AU - Carroccio,A, PY - 1998/10/15/pubmed PY - 1998/10/15/medline PY - 1998/10/15/entrez SP - 1100 EP - 4 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 339 IS - 16 N2 - 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 two 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. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/9770556/full_citation L2 - http://www.nejm.org/doi/full/10.1056/NEJM199810153391602?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -