Proximal small bowel transit pattern in patients with malabsorption induced by bovine milk protein ingestion

Cows' Milk Allergy-Associated Constipation: When to Look for It? A Narrative Review

Constipation is a very common disorder, mostly functional in nature, that may persist for years in up to 35-52% of children. Food allergy prevalence, severity and persistence are increasing over time, and cows' milk protein is the commonest food allergen recognised to affect gastrointestinal motility in children. There is mounting evidence of the role of cows' milk (CM) allergy (CMA) in children with constipation. With this narrative review, we aim to provide clinicians with an updated and critical overview of food allergy-associated constipation. We searched Embase, Medline and the Cochrane Library, using keywords related to the topic. Only reviews and studies including children aged 0-17 years that were published in English were considered. Constipation has been reported in 4.6% of infants with CMA; the prevalence of food allergy underlying chronic constipation in children resistant to conventional treatment and presenting to tertiary clinics ranges between 28% and 78%. The identification of predisposing risk factors and of a specific phenotype of food allergy-induced constipation remains elusive. No allergic tests, radiological or motility investigations achieve sufficient sensitivity and specificity to screen children for CMA-related constipation. A 4-week cows' milk protein (CMP) elimination diet may be considered for children with chronic constipation resistant to conventional treatment and who lack alarm sign/symptoms of organic diseases. In subjects with ameliorated symptoms on CMP elimination, the diagnosis of CMA should be confirmed by a food challenge to avoid an unnecessary protracted diet.

Food allergy alters jejunal circular muscle contractility and induces local inflammatory cytokine expression in a mouse model

Background

We hypothesized that food allergy causes a state of non-specific jejunal dysmotility. This was tested in a mouse model.

Methods

Balb/c mice were epicutaneously sensitized with ovalbumin and challenged with 10 intragastric ovalbumin administrations every second day. Smooth muscle contractility of isolated circular jejunal sections was studied in organ bath with increasing concentrations of carbamylcholine chloride (carbachol). Smooth muscle layer thickness and mast cell protease-1 (MMCP-1) positive cell density were assayed histologically. Serum MMCP-1 and immunoglobulins were quantified by ELISA, and mRNA expressions of IFN-γ, IL-4, IL-6 and TGFβ-1 from jejunal and ileal tissue segments were analyzed with quantitative real-time PCR.

Results

Ovalbumin-specific serum IgE correlated with jejunal MMCP-1⁺ cell density. In the allergic mice, higher concentrations of carbachol were required to reach submaximal muscular stimulation, particularly in preparations derived from mice with diarrhoea. Decreased sensitivity to carbachol was associated with increased expression of IL-4 and IL-6 mRNA in jejunum. Smooth muscle layer thickness, as well as mRNA of IFN-γ and TGF-β1 remained unchanged.

Conclusion

In this mouse model of food allergy, we demonstrated a decreased response to a muscarinic agonist, and increased levels of proinflammatory IL-6 and Th2-related IL-4, but not Th1-related IFN-γ mRNAs in jejunum. IgE levels in serum correlated with the number of jejunal MMCP-1⁺ cells, and predicted diarrhoea. Overall, these changes may reflect a protective mechanism of the gut in food allergy.

Involvement of eicosanoids and macrophage-like cells in cytokine-mediated changes in rat myenteric nerves

BACKGROUND & AIMS

Proinflammatory cytokines alter function in enteric nerves, but little is known about underlying mechanisms. This study was designed to investigate the roles of prostanoids and of macrophage-like cells in cytokine-induced suppression of [3H]norepinephrine release from rat myenteric plexus.

METHODS

The release of 3H from jejunal longitudinal muscle-myenteric plexus preparations that had been loaded with [3H]norepinephrine was measured. Measurements of 3H release as well as concentrations of prostaglandin E2 and leukotriene were made in preparations exposed to interleukin 1 beta plus interleukin 6 and in the presence or absence of piroxicam, 5-lipoxygenase inhibitor MK886, cycloheximide, or cyclosporin A. An ultrastructural analysis was also performed to investigate the presence of macrophage-like cells in the myenteric plexus.

RESULTS

Interleukin 1 beta plus interleukin 6 suppressed 3H release and caused an increase in tissue prostaglandin E2 but not leukotriene E4. Piroxicam and cycloheximide but not MK886 attenuated the cytokine-induced increase in prostaglandin E2 and the suppression of [3H]norepinephrine release. Ultrastructural analysis showed macrophage-like cells in the plexus, and the cytokine effects were inhibited by cyclosporin A.

CONCLUSIONS

Prostanoids but not leukotrienes mediate the cytokine-induced suppression of norepinephrine release, and the results of this study suggest that macrophage-like cells are also involved.

Gastrointestinal food hypersensitivity: basic mechanisms of pathophysiology

Gastrointestinal symptoms occur in a large number of patients with food allergies. Immediate hypersensitivity mechanisms may give rise to the nausea, vomiting, abdominal pain, and diarrhea experienced by these patients. However, there are limited human data about the pathophysiological basis for these symptoms. Most of the available information comes from a variety of animal models. This article reviews the literature using models of intestinal food hypersensitivity, as well as human studies, that have contributed to our understanding of the pathophysiological mechanisms in gastrointestinal food hypersensitivity.

A comparative study of the mouth to caecum transit time in children and adults using a weight adapted lactulose dose

Mouth to caecum transit time (M.C.T.T.) was assessed in 41 subjects divided into 3 age groups (0-1 year, 1-4 years and 22-27 years) with the hydrogen breath test (H.B.T.) using lactulose as the hydrogen source (250 mg/kg; minimal dose 1.5 g in a 10% aqueous solution). The M.C.T.T. remained constant from the second month of age. In children under 1 year of age a high percentage of non-responders was found compared to the older age-groups. In 8 adults two test-substrates, pure lactulose (Legendal, L) and a mixture of lactulose, lactose and galactose (Duphalac, D) were compared. There was no significant difference in M.C.T.T., mean hydrogen production and clinical symptoms using D or L as substrate. We conclude that the H.B.T. using a relative dosage is a suitable test for children, but under the age of 1 year it is less useful because of the high percentage of non-responders. Because of the relation between body height and small bowel length the results suggest an increase in the velocity of the intestinal content with age.