Acquired carbohydrate intolerance and cow milk protein-sensitive enteropathy in young infants

Iyngkaran, N; Abdin, Zainal.; Davis, K. A.; Boey, Christopher Chiong Meng; Prathap, K.; Yadav, M; Lam, Sum; Puthucheary, S. D.

doi:10.1016/s0022-3476(79)80509-0

Cited by 42 publications

(25 citation statements)

References 16 publications

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“…Infectious causes often lead to acute symptoms, but in some cases can result in chronic diarrhea in immunodeficient patients or in persistent diarrhea due to a malabsorptive enteropathy, also termed post-infectious enteropathy. 5 NEC, an important postnatally acquired disorder, is almost always seen in premature infants and is thought to result from gut ischemia and the influx of pro-inflammatory lymphocytes secondary to abnormal gut microbial responses via Toll-like receptor 4 signaling. 6–8 The disease can lead to SBS after gut resection.…”

Section: Causes Of Diarrhea During Early Infancymentioning

confidence: 99%

Advances in Evaluation of Chronic Diarrhea in Infants

et al. 2018

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Diarrhea is common in infants (children less than 2 years of age), usually acute, and, if chronic, commonly caused by allergies and occasionally by infectious agents. Congenital diarrheas and enteropathies (CODEs) are rare causes of devastating chronic diarrhea in infants. Evaluation of CODEs is a lengthy process and infrequently leads to a clear diagnosis. However, genomic analyses and the development of model systems have increased our understanding of CODE pathogenesis. With these advances, a new diagnostic approach is needed. We propose a revised approach to determine causes of diarrhea in infants, including CODEs, based on stool analysis, histologic features, responses to dietary modifications, and genetic tests. After exclusion of common causes of diarrhea in infants, the evaluation proceeds through analyses of stool characteristics (watery, fatty, or bloody) and histologic features, such as the villus to crypt ratio in intestinal biopsies. Infants with CODEs resulting from defects in digestion, absorption, transport of nutrients and electrolytes, or enteroendocrine cell development or function have normal villi to crypt ratios; defects in enterocyte structure or immune-mediated conditions result in an abnormal villus to crypt ratios and morphology. Whole-exome and genome sequencing in the early stages of evaluation can reduce the time required for a definitive diagnosis of CODEs, or lead to identification of new variants associated with these enteropathies. The functional effects of gene mutations can be analyzed in model systems such as enteroids or induced pluripotent stem cells and are facilitated by recent advances in gene editing procedures. Characterization and investigation of new CODE disorders will improve management of patients and advance our understanding of epithelial cells and other cells in the intestinal mucosa.

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Section: Causes Of Diarrhea During Early Infancymentioning

confidence: 99%

Advances in Evaluation of Chronic Diarrhea in Infants

et al. 2018

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“…Our observations hint that feedings of poorly absorbed carbohydrates, such as lactose, can increase jejunal absorption of intact, potentially antigenic, food protein. Diarrheal disease, carbohydrate intolerance, and food protein intolerance are frequently associated (7,14,19,20,23,30) although some questions remain concerning the initiating event. Our data are consistent with the possibility that disaccharide malabsorption might eventually increase intact protein absorption and lead to food protein intolerance in a genetically susceptible host (1 1, 13,14,17,47,48).…”

Section: Discussionmentioning

confidence: 99%

“…Another group of rats received lactose or maltose at 30 g. 23). Some studies suggest that milk protein intolerance can be a kg-'.day-' as a 16.7% purified disaccharide supplement to the solid secondary result of lactose intolerance (7,14,24,29).…”

Section: Mvbs Multivesicular Bodiesmentioning

confidence: 99%

Disaccharide Feedings Enhance Rat Jejunal Macromolecular Absorption

et al. 1983

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Summaryperiods of feeding at lower disaccharide concentrations, which do not induce symp~oms of intolerance. After the high lactose conDisaccharide feedings to post-weaning rats alters their jejunal centration feedings, there was evidence of morphologic damage to barrier to macromolecular absorption. Penetration of horseradish the epithelium of the jejunal mucosa. ~h~ disaccharide-induced peroxidase (HRP) across the jejunum was enhanced after short-increase in HRp absorption may be mediated by transport from term high concentration gavage (30 g*kg-'*da~-l) Of lactose that endocytotic vesicles across the epithelium (10, 12, 43).produces weight loss, osmotic diarrhea, and jejunal mucosal damage. HRP absorption was also increased by-longer term feedings of lower levels of disaccharide that did not produce body weight MATERIALS AND METHODS alterations, diarrhea, or cell damage. Rats without diarihea and gavaged with 7.5 g-kg-' .day-' of either lactose or maltose showed Animals and diet. Postweaning male rats (~r l : (WI) BR, char1e.s an increase in lumen to blood HRP absorption after 21 days of River Breeding Labs, WilmingtOn* MA) weighing g were feedings. Also, lactose or maltose in the solid food diet at 30 g.used. At this stage of development the rats have low lactase levels kg-'.day.' for 21 days did not lead to diarrhea but produced an (36). rats were fed a powdered Purina Rodent Chow (#5001, increase in jejunal lumen to blood HRP absorption. Rats having Ralston Purina Co., St. Louis, MO) and water ad libitum throughno diarrhea and receiving l5 g.kg-~ of lactose or maltose in out the study. The Purina chow diet contained 50% unrefined the drinking water for 21 days, showed an increase in jejunal HRP complex carbohydrate, 23.0% protein. 6.5% fats, and 6.8% minabsorption. When rats were fed either lactose or maltose for 21 erals. The balance corresponded to fiber, vitamins, and moisture. days glucose absorption became dependent upon the sugar In addition to this diet, disaccharides were experimentally adminconcentration in the perfusion medium. The kinetics of this glucose istered the rats. absorption are compatible with a decrease the 66unstirredv layer.

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“…Clinical gastrointestinal features of postinfectious dietary protein sensitivity Although it was first described more than 15 years ago, post-infectious dietary (milk) protein sensitivity has been reported in refereed journals by only three centers (10)(11)(12)(13)(14). It is difficult to estimate the prevalence of this disorder from the few studies available, but the fact that only three centers have reported the entity may indicate that it is not a common disorder.…”

Section: Pathophysiologymentioning

confidence: 99%

“…In post-infectious dietary protein sensitive enteropathy, the most common symptom is diarrhea with or without vomiting (10)(11)(12)(13)(14)(15). Weight loss, anemia, and protein losing enteropathy have also been described, although colitis has not been frequently reported ( I 0-15).…”

Section: Pathophysiologymentioning

confidence: 99%

Dietary protein sensitivity: is it an important risk factor for persistent diarrhea?

Snyder

1992

Acta Paediatrica

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Although the causes of persistent diarrhea are largely unknown, dietary protein sensitivity has been identified as one possible mechanism. Since nutritional therapy appears to be an essential component of treatment for persistent diarrhea, a clearer understanding of the importance of dietary protein allergy is needed to provide optimal dietary recommendations. This paper reviews the current concepts of the pathophysiology, clinical features and criteria for diagnosis of dietary protein sensitivity. Evaluation of the results of several clinical studies indicates that dietary protein sensitivity does occur especially in young infants fed cows’milk but that it is an uncommon event, especially in older infants and children.

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Acquired carbohydrate intolerance and cow milk protein-sensitive enteropathy in young infants

Cited by 42 publications

References 16 publications

Advances in Evaluation of Chronic Diarrhea in Infants

Advances in Evaluation of Chronic Diarrhea in Infants

Disaccharide Feedings Enhance Rat Jejunal Macromolecular Absorption

Dietary protein sensitivity: is it an important risk factor for persistent diarrhea?

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