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Severity and extent of upper small bowel mucosal damage in cow's milk protein-sensitive enteropathy
N Iyngkaran1, M Yadav, C G Boey
1Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia.
Insights
Cow's milk protein sensitive enteropathy (CMPSE) causes upper small bowel mucosal damage. Severe proximal duodenal and jejunal damage correlates with clinical symptoms in infants with CMPSE.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pathology
- Immunology
Background:
- Cow's milk protein sensitive enteropathy (CMPSE) is a condition affecting infants.
- Understanding the relationship between mucosal damage and clinical presentation is crucial for diagnosis and management.
Purpose of the Study:
- To investigate the correlation between the severity and extent of upper small bowel mucosal damage and the development of clinical symptoms in infants with CMPSE.
- To differentiate the impact of proximal versus distal small bowel involvement.
Main Methods:
- Studied 31 infants (28 with CMPSE, 3 controls).
- Assessed mucosal damage severity and extent in the upper small bowel via biopsies.
- Evaluated clinical symptoms following cow's milk challenge.
- Measured mucosal disaccharidase and alkaline phosphatase levels.
Main Results:
- Infants with severe proximal and distal mucosal changes (Group 1) exhibited clinical symptoms.
- Infants without symptoms (Group 2) showed less severe distal mucosal damage compared to the proximal region.
- Histological scores and enzyme levels (disaccharidase, alkaline phosphatase) were significantly lower in Group 2, with greater depletion proximally.
Conclusions:
- The extent and severity of mucosal damage, particularly in the proximal duodenum and jejunum, are critical factors in the development of clinical symptoms in infants with CMPSE.
- Proximal small bowel involvement appears to play a more significant role in symptom manifestation.
Abstract:
A series of 31 infants, 28 with cow's milk protein sensitive enteropathy (CMPSE) and 3 controls, was studied for severity and extent of mucosal damage of the upper small bowel in relation to the development of clinical symptoms. Following challenge with the offending cow's milk, 18 infants (Group 1) developed severe mucosal changes at both the proximal and distal small bowel mucosa and all of these infants presented with clinical symptoms. The other 10 infants (Group 2) who did not develop clinical symptoms following the challenge had less severe damage to the distal small bowel mucosa as compared to the proximal region. The histological score of both the proximal and distal postchallenge biopsies were significantly lower in Group 2 as compared to Group 1 infants. The mucosal disaccharidase and alkaline phosphatase levels were depleted in both the proximal and distal biopsies following challenge but the depletion was greater in the proximal than the distal biopsies. It is suggested that the extent and severity of mucosal damage to the proximal duodenum and jejunum have a critical bearing on the development of clinical symptoms.