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Cows' milk protein-sensitive enteropathy. An important factor in prolonging diarrhoea of acute infective enteritis in
Insights
Cow's milk protein may prolong diarrhea in infants with acute infective enteritis. Very young infants (<2 months) showed jejunal damage and diarrhea upon re-exposure to cow's milk protein after initial treatment.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Infectious Diseases
Background:
- Acute infective enteritis is common in infants.
- Cow's milk protein (CMP) is a common allergen and dietary component.
- The role of CMP in persistent diarrhea in infants with enteritis is not fully understood.
Purpose of the Study:
- To investigate the role of CMP in prolonging diarrhea in infants with acute infective enteritis.
- To assess the impact of CMP re-challenge on jejunal mucosa and immune response in infants.
Main Methods:
- 14 infants with acute infective enteritis were studied (9 <2 months, 5 >6 months).
- Infants were treated and maintained on a CMP-free formula.
- Jejunal biopsies, immunoglobulin, and complement levels were assessed before and after CMP challenge.
- Stool cultures were performed to identify pathogens.
Main Results:
- Older infants (>6 months) tolerated CMP challenge with normal jejunal biopsies.
- Infants under 2 months showed significant jejunal histological changes post-CMP challenge.
- Five infants under 2 months developed diarrhea after CMP re-challenge.
- Bacterial pathogens were isolated from 4 younger infants initially.
Conclusions:
- The jejunal mucosa of very young infants (<2 months) with a history of CMP-based formula and enteritis is susceptible to damage upon CMP re-challenge.
- CMP may contribute to prolonged diarrhea in this vulnerable infant population.
- Age is a critical factor in the response to CMP re-challenge after infective enteritis.
Abstract:
The possible role of cows' milk protein in prolonging diarrhoea in very young infants with acute infective enteritis was studied in 14 infants, 9 under the age of 2 months and 5 older than 6 months. Bacterial pathogens were isolated from the stools of 4 infants from the younger age group. After appropriate initial treatment the infants were maintained on a cows' milk protein-free formula. 6 weeks later jejunal biopsies were performed before and 24 hours after challenge with a low lactose cows' milk protein formula. The immunoglobulin and complement levels in the serum and duodenal juice were also estimated at these times. Attempts to isolate bacterial and viral pathogens in stools were again made in all patients. The 5 older infants clinically tolerated cows' milk protein and their pre- and postchallenge jejunal biopsies were within normal limits. However, significant histological changes were observed in the postchallenge jejunal biopsies of all 9 infants under 2 months of age. In addition, 5 of these infants developed diarrhoea. This suggests that the jejunal mucosa of very young infants previously fed a cows' milk protein-based formula and who contract infective enteritis suffers damage when rechallenged with cows' milk protein.