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Chronic constipation and food intolerance: a model of proctitis causing constipation
Antonio Carroccio1, Calogero Scalici, Emiliano Maresi
1Department of Internal Medicine, University Hospital of Palermo, Palermo, Italy. acarroccio@hotmail.com
Scandinavian Journal of Gastroenterology
|April 22, 2005
Summary
Cow's milk intolerance (CMI) and food intolerances can cause chronic constipation in children, linked to rectal inflammation (proctitis) and reduced mucus. Dietary changes can reverse these histologic changes.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pathology
Background:
- Chronic constipation is a common pediatric issue.
- Cow's milk intolerance (CMI) is a potential cause, but its link to proctitis is debated.
Purpose of the Study:
- To investigate the histologic characteristics of rectal mucosa in children with food intolerance-related constipation.
- To determine if food intolerance causes proctitis.
Main Methods:
- 52 children with chronic constipation underwent elimination diets (cow's milk-free, then oligoantigenic).
- Histologic rectal mucosa analysis (including lymphocytes and eosinophils) and rectal mucus gel layer thickness were assessed.
- Double-blind food challenges confirmed diagnoses in responsive patients.
Main Results:
- 24 patients had CMI, 6 had multiple food intolerances; they improved on diet and relapsed upon challenge.
- Food-intolerant patients showed increased mucosal erosions, intraepithelial lymphocytes, and eosinophils.
- Reduced rectal mucus gel layer thickness was observed in food-intolerant children.
Conclusions:
- Food intolerance-related constipation is associated with rectal eosinophilic proctitis.
- A diminished mucus gel layer may contribute to the pathogenesis of constipation in these children.