Turunen Sami, Karttunen Tuomo J, Kokkonen Jorma
Department of Pediatrics, University Hospital Oulu, Finland.
J Pediatr. 2004 Nov;145(5):606-11. doi: 10.1016/j.jpeds.2004.06.067.
To investigate the incidence of cow's milk allergy as evidenced by milk challenge and the findings of endoscopic and immunohistochemical examinations in children with chronic and refractory constipation.
Thirty-five study subjects (mean age, 8.3 +/- 3.3 years; range, 3-15 years; 17 girls) and 15 control subjects (mean age, 11.7 +/- 3.2 years; range, 2-15 years; 9 girls) were studied by colonoscopy and a 4-week cow's milk elimination and challenge.
Lymphoid nodular hyperplasia was the most prominent endoscopic finding in half of the subjects (46%), mostly occurring patchily in the transverse colon. Histologic findings other than lymphoid accumulation and mildly increased density of eosinophils were few. During the milk elimination and with supportive medication, 83% of subjects remitted. Constipation and/or other gastrointestinal or skin symptoms relapsed only in one third (34%) during the cow's milk challenge, these having significantly higher densities of intraepithelial gammadelta + T cells ( P <.001) in the biopsy samples of the terminal ileum as compared with the control subjects.
We were able to find formal evidence for the presence of cow's milk allergy in children with chronic constipation.
通过牛奶激发试验以及对慢性难治性便秘患儿进行内镜和免疫组化检查，调查牛奶过敏的发生率。
对35名研究对象（平均年龄8.3±3.3岁；范围3 - 15岁；17名女孩）和15名对照对象（平均年龄11.7±3.2岁；范围2 - 15岁；9名女孩）进行结肠镜检查以及为期4周的牛奶排除和激发试验。
淋巴样结节增生是半数研究对象（46%）最显著的内镜检查发现，大多散在分布于横结肠。除淋巴细胞聚集和嗜酸性粒细胞密度轻度增加外，组织学检查结果较少。在牛奶排除期并给予支持性药物治疗后，83%的研究对象症状缓解。在牛奶激发试验期间，便秘和/或其他胃肠道或皮肤症状仅在三分之一（34%）的研究对象中复发，这些对象回肠末端活检样本中的上皮内γδ + T细胞密度显著高于对照对象（P <.001）。
我们能够找到慢性便秘患儿存在牛奶过敏的确切证据。
