Disaccharide intolerance in the aetiology of chronic and-or recurrent diarrhoea in young children.
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Carbohydrate Metabolism, Inborn Errors↗
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[Clinical aspects of cow milk protein and gluten intolerance in children].
In two comparative groups of 50 children with cow milk proteins and 45 children with gluten intolerance retrospective analysis of initial symptoms was carried out. The initial symptoms of intolerance included: vomiting, loss of appetite, recurrent diarrhoea, and weight gain disorders. These symptoms closely correlated with the type of nutrition (mixed, artificial) and the duration of exposition to harmful component of the food. The symptoms appeared within first days after birth with peak intensity in 6-8 weeks of life in the group with cow milk proteins intolerance. The symptoms of intolerance were most frequent in children of group II in 7-12 months of life. To prevent food intolerance in Polish children, it is recommended to feed them naturally as long as possible and to introduce flour and 4 basic grains late (after the 6th months of life).
Animals↗
Diarrhoea in kwashiorkor.
Diarrhoea was a common problem in the kwashiorkor seen in Kampala, contributing to the mortality and delay in recovery. Enteric infection was found in only a few children (8%), but when present it caused particularly severe diarrhoea and was frequently complicated by septicaemia.Sugar intolerance often occurred to lactose and other sugars, both monosaccharide and disaccharide. The children were most commonly intolerant of lactose, and some of these may have had a hereditary lactase deficiency.Antibiotics are rarely indicated for the treatment of diarrhoea in kwashiorkor in Kampala. If reducing substances are found in the stool of a child on a milk diet, a diet based on sucrose is substituted, and if intolerance persists a fructose diet is given. A few children are intolerant of all sugars, including fructose, and for these the prognosis is grave.
Carbohydrate Metabolism, Inborn Errors↗
Role of alimentation in irritable bowel syndrome.
BACKGROUND: Different food items are made responsible for irritable bowel syndrome (IBS) symptoms, but the physiopathology of IBS remains unclear. AIMS: During a meeting in Nice, France, experts of the European Working Team of the IBiS Club discussed selected data regarding the relationships between alimentation, food items (including fibers) and IBS symptoms. METHODS/RESULTS: Food allergy remains a difficult diagnosis, but medical and general history, presence of general symptoms such as skin rash, and hypersensitivity tests may help in achieving a positive diagnosis. On the other hand, food intolerance is more confusing because of the subjectivity of the relationship between ingestion of certain foods and the appearance of clinical symptoms. Different food items which are commonly implicated in adverse reactions mimicking IBS were found to be stimulants for the gut, suggesting that patients with predominant diarrhea IBS have to be carefully questioned about consumption of different kinds of food (i.e., coffee, alcohol, chewing gum, soft drinks) and not only on lactose ingestion. Gas production is discussed on the basis of retention of intestinal gas as well as on malabsorption of fermentable substrates. The role of a large amount of this kind of substrate reaching the colon is suggested as a potential mechanism of IBS-type symptoms in overeating patients. Regarding the role of fiber in IBS, the expert group concluded that fibers are not inert substances and that they could trigger pain or bloating in some IBS patients. CONCLUSION: Despite numerous reviews on this subject, it is very difficult to give general dietary advice to IBS patients, but dieteticians may have a positive role in managing such patients.
Colon↗
[Immunopathology of the digestive apparatus in infancy].
The infant acquires immunological competence in the neonatal period through the passage of antigens from the enteric lumen through gut-associated lymphoid tissues, principally the Peyer's patches and the appendix. Immune deficient mechanisms may be involved in several gastrointestinal diseases manifesting in the neonatal period as well as throughout childhood. Principally among these are neonatal necrotising enterocolitis, atopy and food intolerances, coeliac disease, cow's milk protein intolerance, diarrhoea associated with hypogammaglobulinaemia, malnutrition and inflammatory bowel disease. The mechanism whereby immune reactions are involved in the pathogenesis of these diseases is discussed.
B-Lymphocytes↗
[Possibilities and limits of the H2 breath test].
The hydrogen breath test has been introduced as a non-invasive and reproducible test for the detection of milk intolerance, bacterial overgrowth and intestinal motility disorders. In our hands the semiquantitative assessment of mucosal lactase activity and the non-invasive monitoring of antimicrobial treatment in bacterial overgrowth were further attractive facettes of this test.
Bacterial Infections↗
Adverse reactions to food constituents: allergy, intolerance, and autoimmunity.
Food allergies and intolerance represent important health concerns to consumers who are predisposed to these illnesses. Unlike many current food safety issues, food sensitivities are complicated by both complex and multiple individual adverse reactions, which can vary from emotional to pathophysiological ailments. In some instances, the underlying mechanisms that result in the development of food allergies or intolerance have marked differences but produce common symptoms. The present-day diagnosis of these disorders can be impeded by intrinsic limitations in generating accurate information from patient history and biochemical, physicochemical, and immunochemical tests. Oral challenge tests represent effective methods for confirming and testing food allergens and food intolerance; however, these procedures are often restricted to clinical trials. It is important to be able to distinguish among food allergy, intolerance, and autoimmune disease in the management of these disorders. The role of food in the development of autoimmune disease may be exemplified by celiac disease, a food-induced enteropathy, requiring exposure to prolamins in wheat, rye, and barley. Various wheat and soy protein sources, including the soy protein isolates used to make infant formulas, have been related to juvenile or insulin-dependent diabetes mellitus (IDDM), a common chronic disease of childhood. Employing food process technologies to eliminate food constituents with potential for intolerance in some individuals is a potentially viable approach for reducing risk to food-related disorders. Finally, the development of food labelling regulations that require the identification of potential food allergens or agents for intolerance in the ingredient declaration on prepackaged food is a positive step toward the prevention of severe adverse reactions in hypersensitive individuals.
Animals↗
Oral health in coeliac disease and cow's milk protein intolerance.
The oral health of 24 children and adolescents, 19 with coeliac disease (CD) and 5 with cow's milk protein intolerance (CMPI) were compared with that of 24 randomly selected paired controls. Mineralisation disorders in the form of hypoplasias and/or opacities occurred in 74% of the cases of CD and 68% of their controls. All 5 cases with CMPI had mineralisation disorders, as did 2 of their controls. The disorders usually took the form of opacities, and both these and the hypoplasias were of a mild nature in all the groups. Serious hypoplasias did not occur at all. The caries status was, on average, better in the CD and CMPI groups than in the controls. Recurrent oral lesions occurred with almost the same frequency in the intolerance groups and in the controls. The study, therefore, gave no clear evidence that CD or CMPI involves a significant risk of poorer oral health, provided adequate paediatric and dental care is given.
Adolescent↗
Enteric infections, cow's milk intolerance and parenteral infections in 118 consecutive cases of acute diarrhoea in children.
One hundred and eighteen consecutive cases of childhood acute diarrhoea (mean age: 10.5 months) were studied after admission to our Pediatric Unit in Naples over a 13-month period. A diagnosis was established in 92 patients (78%): 55% of patients were found to have an infectious enteritis (among them, 5 had ETEC infections and 1 had an ST-producing Klebsiella infection), 12% a parenteral infection, 11% cow's milk intolerance. The occurrence of gross blood (P less than 0.01), leukocytes, and reducing substances in the stools was more commonly associated with infectious enteritis than with diarrhoea due to all other causes. In 14 patients (8 of whom were malnourished), diarrhoea ran a prolonged course. In all, the eventual outcome was favourable. Our findings, while confirming that infectious enteritides account for most of acute diarrhoeas in children, stress the importance of parenteral infections and cow's milk intolerance in this condition. Also, the need for an accurate search for enterotoxigenicity of enterobacteria before ruling out their pathogenetic role is stressed.
Bacterial Infections↗
The significance of lowered jejunal disaccharidase levels.
Disaccharidase estimations on 115 consecutive jejunal biopsies are reported. The patients were divided into four groups: 1. Normal jejunal biopsy light microscopy, not milk intolerant, 82 cases. 2. Normal jejunal biopsy light microscopy, milk intolerant, eight cases. 3. Patients with giardiasis, 11 cases. 4. Coeliac disease patients, 14 cases. The lowest disaccharidase levels were found in coeliac disease, with giardiasis cases showing intermediate levels. Poor correlation of lactase levels with milk intolerance was found. Three cases in Group 1 showing lowered lactase levels were given metronidazole and showed remission of clinical symptoms, raising the possibility that they had undiagnosed infections with Giardia lamblia.
Adolescent↗
Formula allergy and intolerance.
There are two major types of adverse reactions in infant formulas: (1) formula allergy/hypersensitivity, which is an immunologic response, and (2) formula intolerance, which is a nonimmunologic response. Formula intolerance can occur in infants with an underlying congenital or acquired enzyme deficiency (disaccharidase deficiency, galactosemia, hereditary fructose intolerance). The clinical presentation, diagnosis, and treatment of both reactions are reviewed in this article. The appropriateness of the use of a variety of infant formulas is discussed. Guidelines for the prevention of allergic disease are described as well.
Carbohydrate Metabolism, Inborn Errors↗
[Intolerance to cow's milk protein. A complication of acute gastroenteritis (author's transl)].
Eight cases of acute gastroenteritis, two caused by enteropathogenic "E. coli", with secondary cow's milk protein intolerance were studied. Diagnosis was established clinically and by means of intestinal biopsy, before and after a milk challenge. The role of acute gastroenteritis as a trigger of cow's milk protein intolerance and other factors contributing to the appearance of that complication are discussed. The mechanisms leading to intractable diarrhoea in a situation of prolonged gastroenteritis are also commented.
Diagnosis, Differential↗
Gastrointestinal food allergy and intolerance.
GI symptoms are a common manifestation of food allergy and intolerance. The primary physician is the first to evaluate these symptoms. A systematic evaluation using an accurate and detailed history, tests to identify the offending food(s), and procedures that may identify underlying pathologic disorders of the GI tract would lead to an accurate diagnosis and better targeted therapeutic interventions.
Abdominal Pain↗
Tolerance of a milk-based formula by infants.
A standard, low-iron, milk-based formula was fed to 781 healthy infants younger than 12 months of age. The infants showed normal increases in weight and length during the study. The formula was well tolerated by most of the infants. The most frequently reported symptoms of intolerance before and during the study were loose stools (in 78%) and spitting up (in 79%). A significant decrease from before to after the study was reported in the symptoms of colic, constipation, diarrhea, loose stools, skin rashes, and spitting up. It is concluded that a standard milk-based formula is well tolerated by most healthy infants.
Body Height↗
[Clinical forms of cow milk protein intolerance in children].
Fifty children aged between 2 months and 5 years with intolerance of cow milk proteins were analysed. The children were hospitalized between 1978 and 1984. The following clinical forms of protein intolerance were distinguished and characterized: gastro-enteric, skin, constitutional-cerebral with the respiratory and laryngological symptoms, and shock. An emphasis is on certain clinical symptoms characteristic for particular forms. Elimination of cow milk from the diet of these children during hospitalization period and following out-patient treatment has led to complete diminishment of the clinical symptoms.
Animals↗
[Specific IgE antibodies to cow's milk and individual cow's milk proteins in children with suspected allergy to cow's milk].
Specific IgE antibodies against whole-milk-antigen mixture and against casein, alpha-lactalbumin and beta-lactoglobulin were determined using the radioallergosorbent test (RAST) in 125 sera of children with an initial diagnosis of suspected cow milk allergy. The results of the RAST were correlated with the clinical diagnosis. No specific IgE antibodies could be demonstrated in 98 children. Of these, 20 (20%) showed clinically intolerance to cow milk presumably on the basis of other immunological mechanisms. Specific IgE antibodies could be demonstrated in the sera of 27 children. Of these, 16 (60%) actually showed allergy to cow milk. A statistically significant association with chi 2 test could be established between positive RAST and clinical diagnosis (p = 0.001).
Adolescent↗
The intestinal microvillus. Ultrastructural variability in coeliac disease and cow's milk intolerance.
In 8 patients with coeliac disease, 2 patients with cow's milk intolerance and 10 patients with other gastrointestinal disturbances, intestinal biopsies were examined in order to compare the extent of alteration of surface vs. crypt microvilli (MV). In those diseases associated with the ingestion of a noxious agent, namely coeliac disease and cow's milk intolerance, a marked and abrupt difference between the severely damaged surface epithelium and its MV, and the preserved crypt epithelium was noted. The results of the examinations give reason to suppose that these morphological variations are caused by the higher gliadin or milk protein concentration over the avillous surface epithelium as opposed to the lower one in the elongated crypts.
Adolescent↗
Sonographic demonstration of malabsorption in neonates.
A new sonographic pattern is described that has been found in eight infants having syndromes associated with malabsorption. Five infants had hepatobiliary disease and three infants had transient or permanent cow-milk intolerance. In all cases, upper abdominal sonographic examinations revealed hyperechoic tubular and round masses which, most probably, represent small bowel loops filled with malabsorbed milk. Control examinations, before hepatic failure or under corrected diet, showed absence of the pattern. It is believed by the authors that in some ambiguous cases, the finding of this pattern should direct the pediatrician toward syndromes associated with malabsorption.
Bile Ducts↗