Iacono G, Cavataio F, Montalto G, Florena A, Tumminello M, Soresi M, Notarbartolo A, Carroccio A
Divisione di Pediatria, Ospedale G. Di Cristina, Palermo, Italy.
N Engl J Med. 1998 Oct 15;339(16):1100-4. doi: 10.1056/NEJM199810153391602.
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.
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.
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).
In young children, chronic constipation can be a manifestation of intolerance of cow's milk.
慢性腹泻是儿童牛奶不耐受最常见的胃肠道症状。基于之前的一项开放性研究，我们推测牛奶不耐受也可导致幼儿出现严重的肛周病变、排便时疼痛以及随之而来的便秘。
我们进行了一项双盲交叉研究，比较牛奶与豆奶对65名慢性便秘儿童（年龄范围为11至72个月，慢性便秘定义为每3至15天排便一次）的影响。所有儿童均被转诊至儿科胃肠病诊所，此前使用泻药治疗均无效；其中49名儿童有肛裂及肛周红斑或水肿。观察15天后，患者接受为期两周的牛奶或豆奶喂养。经过一周的洗脱期后，喂养方式互换。治疗期间排便8次或更多次被定义为有反应。
65名儿童中有44名（68%）在接受豆奶喂养时有反应。肛裂及排便疼痛症状消失。接受牛奶喂养的儿童均无反应。在所有44名有反应的儿童中，通过牛奶双盲激发试验证实了反应情况。有反应的儿童比无反应的儿童并发鼻炎、皮炎或支气管痉挛的频率更高（44名儿童中有11名，21名儿童中有1名，P = 0.05）；他们在基线时也更有可能出现肛裂及红斑或水肿（44名中有40名，21名中有9名，P<0.001），活检时有直肠黏膜炎症的证据（44名中有26名，21名中有5名，P = 0.008），以及过敏迹象，如针对牛奶抗原的特异性IgE抗体（44名中有31名，21名中有4名，P<0.001）。
在幼儿中，慢性便秘可能是牛奶不耐受的一种表现。
