Cow's milk protein intolerance and chronic constipation in children

Abstract

Cow's milk protein (CMP) allergy was investigated in 25 children (age-range 3 months to 11 years) with chronic constipation. A diagnosis of constipation was made on the basis of a history of painful elimination of hard stools for at least 1 month, whether or not associated with a reduced frequency of stools or soiling. The children were evaluated using clinical parameters and the following laboratory tests: total serum immunoglobulin E (IgE); specific IgE (radioallergosorbent test [RAST]) for whole cow's milk, alpha-lactoalbumin, beta-lactoglobulin, and a food group; and skin-prick tests with whole milk, alpha-lactoalbumin, beta-lactoglobulin, and casein. Following the evaluation, the children were submitted to a CMP-free diet for a period of 4 weeks. In seven patients (28%), constipation disappeared during the CMP-free diet and reappeared within 48-72 h following challenge with cow's milk. In two infants a rectal biopsy revealed allergic colitis and they therefore did not undergo the challenge. High serum levels of total IgE were observed in five of the children who showed a clinical improvement (71%), a positive skin-test in two (29%), and detectable specific IgE in two (29%). These results suggest that CMP allergy or intolerance should be considered as a cause of chronic refractory constipation in children, although the underlying mechanism still require further investigation.

Food intolerance and chronic constipation: manometry and histology study

“…Although our and others' studies have shown the relationship between cows' milk protein intolerance (CMPI) and chronic constipation [3][4][5][11][12][13], very little is known about the pathogenesis of chronic constipation caused by CMPI. Consequently, we performed this study Table 3 Anorectal manometry results in patients with food intolerance-related chronic constipation at entry to the study and after 12 weeks of elimination diet, and in patients with chronic constipation not related to food intolerance…”

“…According to the European Society Pediatric Gastroenterology Hepatology and Nutrition diagnostic criteria for food intolerance/allergy [14], we can affirm that half of the patients included in the study (17 out of 36) were suffering from food intolerance that caused chronic constipation. As studies from other centres showed a frequency of constipation caused by CMI ranging between 28 and 70% [11][12][13], it can be concluded that in patients unresponsive to conventional treatments or with a personal history of CMI, constipation is quite frequently a manifestation of food intolerance.…”

Constipation in infants: influence of type of feeding and dietary fiber intake

“…Outro aspecto relaciona-se com a boa digestibilidade dos lipídeos do leite humano em relação às fórmulas, o que favorece a formação de fezes menos consistentes 22 . Após o desmame, alguns casos de constipação podem ser atribuí-dos à intolerância ou alergia à proteína do leite de vaca [23][24][25] . Acrescentando-se essas evidências fisiológicas 20,21 e patológicas [21][22][23] aos resultados do nosso estudo, o aleitamento natural deve ser considerado como um fator de proteção contra o desenvolvimento de constipação.…”

Constipation

“…Nas seis crianças que realizaram biópsia retal observou-se infiltrado de eosinófilos na lâmina pró-pria. Outro estudo 48 foi realizado em São Paulo. Dieta sem leite de vaca foi recomendada para 40 pacientes com constipação atendidos em ambulatório especializado.…”