Intolerance of cow's milk and chronic constipation in children

N Engl J Med. 1998 Oct 15;339(16):1100-4. doi: 10.1056/NEJM199810153391602.

Abstract

Background: Chronic diarrhea is the most common gastrointestinal symptom of intolerance of cow's milk among children. On the basis of a prior open study, we hypothesized that intolerance of cow's milk can also cause severe perianal lesions with pain on defecation and consequent constipation in young children.

Methods: We performed a double-blind, crossover study comparing cow's milk with soy milk in 65 children (age range, 11 to 72 months) with chronic constipation (defined as having one bowel movement every 3 to 15 days). All had been referred to a pediatric gastroenterology clinic and had previously been treated with laxatives without success; 49 had anal fissures and perianal erythema or edema. After 15 days of observation, the patients received cow's milk or soy milk for two weeks. After a one-week washout period, the feedings were reversed. A response was defined as eight or more bowel movements during a treatment period.

Results: Forty-four of the 65 children (68 percent) had a response while receiving soy milk. Anal fissures and pain with defecation resolved. None of the children who received cow's milk had a response. In all 44 children with a response, the response was confirmed with a double-blind challenge with cow's milk. Children with a response had a higher frequency of coexistent rhinitis, dermatitis, or bronchospasm than those with no response (11 of 44 children vs. 1 of 21, P=0.05); they were also more likely to have anal fissures and erythema or edema at base line (40 of 44 vs. 9 of 21, P<0.001), evidence of inflammation of the rectal mucosa on biopsy (26 of 44 vs. 5 of 21, P=0.008), and signs of hypersensitivity, such as specific IgE antibodies to cow's-milk antigens (31 of 44 vs. 4 of 21, P<0.001).

Conclusions: In young children, chronic constipation can be a manifestation of intolerance of cow's milk.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Animals
  • Child, Preschool
  • Chronic Disease
  • Constipation / etiology*
  • Constipation / pathology
  • Cross-Over Studies
  • Double-Blind Method
  • Eosinophils
  • Female
  • Fissure in Ano / etiology
  • Glycine max
  • Humans
  • Infant
  • Infant Food
  • Inflammation / etiology
  • Inflammation / pathology
  • Male
  • Milk / adverse effects*
  • Milk Hypersensitivity / complications*
  • Milk Hypersensitivity / pathology
  • Rectum / pathology