Carroccio Antonio, Di Prima Lidia, Iacono Giuseppe, Florena Ada M, D'Arpa Francesco, Sciumè Carmelo, Cefalù Angelo B, Noto Davide, Averna Maurizio R
Internal Medicine, University Hospital of Palermo, Italy.
Scand J Gastroenterol. 2006 Apr;41(4):498-504. doi: 10.1080/00365520500367400.
Chronic constipation that is unresponsive to laxative treatment is a severe illness, but children unresponsive to laxatives have been successfully treated with an elimination diet. We report the first cases of refractory chronic constipation caused by food hypersensitivity in adults. Four patients with refractory constipation who were unresponsive to high doses of laxatives were put on an oligo-antigenic diet and underwent successive double-blind, placebo-controlled, food challenges (DBPFC). Routine laboratory tests, immunological assays, colonoscopy, esophago-gastroduodenoscopy and rectal and duodenal histology were performed. While on an elimination diet, bowel habits normalized in all patients and a DBPFC challenge triggered the reappearance of constipation. In comparison with another 13 patients with refractory constipation unresponsive to the elimination diet, observed over the same period, the patients with food-hypersensitivity-related constipation had the following characteristics: longer duration of illness (p < 0.03), lower body mass index (p < 0.03), higher frequency of self-reported food intolerance (p < 0.01), higher frequency of nocturnal abdominal pain and anal itching (p < 0.01). In patients with food hypersensitivity, hemoglobin concentrations and peripheral leukocytes were lower than those in controls (p < 0.03). The duodenal and rectal mucosa histology showed lymphocyte and eosinophil infiltration, and the duodenal villi were flattened in two cases. In adult patients, refractory chronic constipation may be caused by food hypersensitivity and an elimination diet is effective in these subjects.
对泻药治疗无反应的慢性便秘是一种严重疾病，但对泻药无反应的儿童通过饮食排除疗法已成功治愈。我们报告了首例成人食物过敏引起的难治性慢性便秘病例。4例对高剂量泻药无反应的难治性便秘患者采用低抗原饮食，并接受连续的双盲、安慰剂对照食物激发试验（DBPFC）。进行了常规实验室检查、免疫测定、结肠镜检查、食管胃十二指肠镜检查以及直肠和十二指肠组织学检查。在饮食排除期间，所有患者的排便习惯恢复正常，而DBPFC激发试验引发了便秘再次出现。与同期观察的另外13例对饮食排除疗法无反应的难治性便秘患者相比，食物过敏相关便秘患者具有以下特征：病程更长（p<0.03）、体重指数更低（p<0.03）、自我报告的食物不耐受频率更高（p<0.01）、夜间腹痛和肛门瘙痒频率更高（p<0.01）。食物过敏患者的血红蛋白浓度和外周血白细胞低于对照组（p<0.03）。十二指肠和直肠黏膜组织学显示淋巴细胞和嗜酸性粒细胞浸润，2例患者十二指肠绒毛变平。在成年患者中，难治性慢性便秘可能由食物过敏引起，饮食排除疗法对这些患者有效。
