Cow's milk protein-sensitive enteropathy at school age

Kokkonen, Jorma; Haapalahti, Mila; Laurila, Kaija; Karttunen, Tuomo J.; Mäki, Markku

doi:10.1067/mpd.2001.118882

Cited by 84 publications

(68 citation statements)

References 17 publications

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“…It is probable that the negative IgE-mediated assays in these patients had contributed to a misdiagnosis, but previous articles on children with FH and endoscopic evidence of LNH showed that the skin prick test and food-specific IgE antibodies were negative. 9,17 Consequently, although gastroenterology manifestations of FH in adults are considered rare, 18,19 we suggest that a higher level of suspicion with more frequent recourse to the elimination diet and DBPC challenge could evidence a higher frequency of FH diagnoses.…”

Section: Discussionmentioning

confidence: 89%

Food Hypersensitivity as a Cause of Rectal Bleeding in Adults

Carroccio

Iacono

Prima

et al. 2009

Clinical Gastroenterology and Hepatology

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Section: Discussionmentioning

confidence: 89%

Food Hypersensitivity as a Cause of Rectal Bleeding in Adults

Carroccio

Iacono

Prima

et al. 2009

Clinical Gastroenterology and Hepatology

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“…Nessa ocasião, procurou nosso serviço. Exames: hemoglobina 10,2 g/dl, hematócrito 32%, 15.600 leucócitos (neutrófilos bastonados 8%, neutrófilos segmentados 47%, eosinófilos 3%, linfócitos 36% e monó-citos 6%); os testes de coagulação apresentaram-se normais. A endoscopia digestiva alta mostrou pangastrite erosiva hemorrágica, que foi atribuída à ingestão de ácido acetilsalicílico, pois a mãe administrava regularmente (50mg/dia) para debelar cólicas.…”

Section: Descrição De Casosunclassified

“…Anormalidades endoscópicas, especialmente esofagite, erosões gástricas, erosões duodenais e hiperplasia nodular linfóide no duodeno são freqüentes em pacientes com alergia alimentar, e provavelmente são subdiagnosticadas 14 . Erosões gástricas estavam presentes em 3/15 pacientes com dor abdominal e diarréia, com diagnóstico de alergia alimentar estabelecido com desencadeamento duplo-cego placebo controlado, embora nenhum deles tivesse apresentado hemorragia digestiva 15 . A região do antro gástrico sempre apresenta padrão inflamatório com eosinofilia tecidual, enquanto no corpo gástrico as alterações são focais 16 .…”

Section: Comentáriosunclassified

Gastrite hemorrágica por alergia ao leite de vaca: relato de dois casos

Machado¹,

Kawakami²,

Goshima³

et al. 2003

J. Pediatr. (Rio J.)

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Artigo submetido em 17.02.03, aceito em 28.05.03. ResumoObjetivo: descrever dois lactentes com gastrite hemorrágica, devido à alergia ao leite de vaca.Descrição dos casos: ambos os pacientes apresentavam hematêmese, vômitos e desnutrição. Os pacientes apresentavam infiltrado eosinofílico em mucosa gástrica biopsiada e resolução dos sintomas após o início de dieta com exclusão da proteína do leite de vaca.Comentários: gastrite hemorrágica devido à alergia ao leite de vaca é um diagnóstico incomum. Até o momento foram relatados 10 pacientes com gastrite alérgica, e as principais manifestações clíni-cas são vômitos, desnutrição, anemia e hematêmese. A gastrite por alergia ao leite de vaca pode apresentar-se em diferentes graus de gravidade, e pode ser subdiagnosticada em muitos pacientes. A menos que o tratamento correto seja iniciado, o paciente desenvolverá desnutrição protéico-calórica grave e anemia. Doença alérgica do trato gastrointestinal superior deve ser considerada em todos os lactentes com vômitos recorrentes, particularmente se complicado com hematêmese. O diagnóstico de gastrite alérgica é clínico, auxiliado pela endoscopia e anatomia patológica.J Pediatr (Rio J) 2003;79(4):363-8: gastrite hemorrágica, alergia ao leite de vaca, lactentes. AbstractObjective: to report two cases of infants with hemorrhagic gastritis due to cow's milk allergy.Description: the clinical features included hematemesis, vomiting and malnutrition. All patients had eosinophilic infiltrate in gastric biopsies and got favorable clinical outcome after cow's milk free diet.Comments: hemorrhagic gastritis due to cow's milk allergy is an uncommon diagnosis. Clinical findings in 10 patients (including ours) reported with allergic gastritis were vomiting, malnutrition, anemia, and hematemesis. Gastritis occurs in cow's milk allergy in a wide range of severity, and it could remain hidden in most patients. Unless appropriate management is ensued, patients develop severe malnutrition and severe anemia. Allergic compromise of upper gastrointestinal tract might be considered in all vomiting infants particularly if complicated by hematemesis. Diagnosis of allergic gastritis relies on clinical suspicion helped by endoscopy and gastric biopsies. As manifestações gastrointestinais de alergia alimentar incluem diarréia crônica com má absorção, sangramento retal, refluxo gastroesofágico, constipação intestinal e hemorragia digestiva alta [1][2][3][4] . Refluxo gastroesofágico (RGE) e alergia ao leite de vaca (ALV) são considerados os distúrbios gastrointestinais mais comuns em lactentes no primeiro ano de vida, e, muitas vezes, são patologias relacionadas 3,5 . Vômitos persistentes, ganho ponderal in- J Pediatr (Rio

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“…All CD subjects were positive for endomysium antibodies. The same series of patients had been used in previous studies evaluating granzymes (4), mucosal apoptosis (15), cytotoxic lymphocytes (2), gamma/delta T-cell receptor expression (16) and cytokine profiles (17). For the Western blot analysis we had an additional series of3 patients with untreated CD (mean age 6.3 years, range 4-11 years; 2 females) and 4 control subjects (mean age 8.2 years, range 6-10 years, 1 female).…”

Section: Patientsmentioning

confidence: 99%

Decreased Expression of Protease Inhibitor 9, a Granzyme B Inhibitor, in Celiac Disease: A Potential Mechanism in Enterocyte Destruction and Villous Atrophy

Pohjanen

Arvonen

et al. 2013

Int J Immunopathol Pharmacol

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The objective of this study was to assess the expression of protease inhibitor 9, a granzyme B inhibitor, in human small intestine, and to evaluate its cytoprotective role in the celiac disease of children. Twelve subjects with untreated celiac disease and thirteen healthy controls were examined by endoscopy. The expression of protease inhibitor 9 was analyzed immunohistochemically from duodenal biopsies and compared to granzyme B expression, apoptosis rate, number of intraepitheliallymphocytes and villus and crypt height data from the biopsies. We discovered that protease inhibitor 9 is expressed in the cytoplasm of the duodenal epithelial cells in the majority of cases. The enterocyte expression of protease inhibitor 9 was lower in celiac disease patients than in controls. Protease inhibitor 9 expression also showed a negative correlation with the number of apoptotic cells, overall density of granzyme B expressing intraepithelial lymphocytes, the height of the crypts and the severity of villous atrophy in duodenum. Therefore, we conclude that the protease inhibitor 9 is constantly expressed in the enterocytes of normal duodenum and the expression is decreased in celiac disease. These findings suggest that protease inhibitor 9 has a role in duodenal homeostasis and in the protection of enterocytes from misdirected granzyme B. Indeed, observed associations of lowered protease inhibitor 9 expression together with increased granzyme B expression, apoptosis rate and severity of villous atrophy suggest that impaired balance between granzyme B mediated cytotoxicity and its inhibition by protease inhibitor 9 forms an important factor in the pathogenesis of villous atrophy in celiac disease.

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Cow's milk protein-sensitive enteropathy at school age

Cited by 84 publications

References 17 publications

Food Hypersensitivity as a Cause of Rectal Bleeding in Adults

Food Hypersensitivity as a Cause of Rectal Bleeding in Adults

Gastrite hemorrágica por alergia ao leite de vaca: relato de dois casos

Decreased Expression of Protease Inhibitor 9, a Granzyme B Inhibitor, in Celiac Disease: A Potential Mechanism in Enterocyte Destruction and Villous Atrophy

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