Gastrointestinal complaints and diagnosis in children: a population-based study.

AIM: To find out the extent to which children at 10-11 y of age suffer from various gastrointestinal complaints and how often a food-induced or other diagnostic disorder might be assessed behind them, we carried out a population-based survey of 404 children in a rural Finnish town. METHODS: A questionnaire filled in retrospectively by their parents was used to describe the frequency of various abdominal symptoms during the previous 2 y and to select the symptomatic subjects for closer clinical examination. In the clinical investigation of the children, an elimination challenge with milk protein and lactose intolerance tests, as well as endoscopic examinations in selected cases and blood tests, were performed. RESULTS: In all, 110 (27%) subjects reported some gastrointestinal (GI) complaints during the last 2 y; 64 (16%) meeting the Apley criteria for recurrent abdominal pain. A specific organic or functional disorder was found in 26 subjects (6%), two having no GI symptoms. Milk protein intolerance was the most common specific disorder diagnosed in nine subjects (2.2%), followed by lactose intolerance in eight (2%), coeliac disease in five (1.2%) and Helicobacter pylori infection in three (0.7%). An endoscopic examination performed on 17 subjects (4.2%) and a colonoscopy on three revealed significant findings in 11; lymphonodular changes being most common, occurring in five subjects. Subjects with milk protein-induced disorders showed significantly lower IgA-class antibodies to milk and its fractions than the non-symptomatic controls. Chronic diseases, short breastfeeding, GI problems and food intolerance during the first year of life were observed as significant risk factors in determining whether a subject belonged to the group experiencing any GI complaints. CONCLUSION: We conclude that in one in five of those with any, even mild, GI complaints we were able to assess a specific organic disease; milk-induced disorders being most common. A milk protein and/or lactose load test, completed in some cases with an endoscopic examination, would help in assessing a proper individual diagnosis.

Food habits in 10-11-year-old children with functional gastrointestinal disorders.

OBJECTIVE: To evaluate the role of food habits and nutrient intake in children with functional gastrointestinal disorders (FGIDs) considering their association with psychosocial factors. DESIGN: Cross-sectional. SETTING: A rural town in Mid-Western Finland. SUBJECTS: After excluding organic gastrointestinal (GI) disorders, a total of 49 children with FGID and 78 control children without GI symptoms from a cohort of 422 children were studied. METHODS: Food frequency questionnaire, GI-symptoms questionnaire and the Child Behaviour Check List (CBCL) filled in by parents together with their child, and 24-h dietary recall and anthropometric and haematological measurements. RESULTS: Compared to control children, fewer children with FGID had daily family dinner (77 vs 91%, P = 0.030) and they used less often vegetables (P = 0.023), fruits (P = 0.027) and berries (P = 0.011), but more often ice cream (P = 0.018) and soft drinks (P = 0.027) and had a higher sucrose intake (9 vs 7E%, P = 0.032) and lower lactose intake (27 vs 36 g, P = 0.001). Reported food-related symptoms were more common among FGID group (69 vs 11%), as well as restricted milk use (31 vs 0%). Children with FGID had higher total problem scores in CBCL (P=0.002), and the behavioural/emotional problems associated with occurrence of FGID (OR 1.04, 95% CI 1.07-1.076) as did the sugar intake (OR 1.1, 95% CI 1.004-1.215). CONCLUSIONS: This population-based study suggests that school-aged children with FGIDs have less-organized food habits and higher milk avoidance, and they display internalizing psychological characteristics. SPONSORSHIP: Juho Vainio Foundation, Finland; the Alma and K.A. Snellman Foundation, Oulu, and the Pediatric Research Foundation, Finland.

Residual intestinal disease after milk allergy in infancy.

BACKGROUND: The subsidence of cow's milk allergy (CMA) has been a subject of controversy. In this study the authors examined whether children with this condition in infancy developed full tolerance or whether they continue to have vague gastrointestinal (GI) symptoms relating to the consumption of milk or dairy products and/or signs of mucosal lesion in the GI tract. METHODS: The authors reexamined 56 10-year-old subjects who manifested CMA before 1 year of age, and compared the results with a group of 204 randomly selected age-matched school children. Fifty-three and 90 subjects respectively attended a reexamination and were evaluated for growth, lactose tolerance, and immunoglobulin A (IgA)- and IgG-class antibodies to whole cow's milk. The subjects reporting milk-related GI symptoms were encouraged to do a 4-week blind elimination-challenge test with 1 week of low-lactose milk flour. Sixteen of the 25 children were able to complete the trial. RESULTS: Approximately half the study subjects (45%) reported milk-related GI symptoms, whereas the respective figure among the control subjects was 10%. Three of six study subjects and seven of 10 control subjects, although completing the challenge, responded with intestinal symptoms. The growth of the former CMA subjects was retarded compared with the control subjects, and the difference in height was most striking in those subjects still reporting milk-related GI symptoms. However, all subjects had normal hemoglobin and whole-blood folic acid levels. The CMA subjects had significantly (P = 0.014) lower concentrations of milk antibodies compared with the control subjects. Lactose malabsorption, defined as high counts in a hydrogen breath test and related clinical symptoms, was found in eight CMA subjects (14%) and six control subjects (3%). CONCLUSIONS: In a certain proportion of subjects with CMA in infancy, GI intolerance seems to persist even after small-dose tolerance has been achieved. The intestinal symptoms and the increased prevalence of lactose intolerance may be caused by a disturbance of the surface epithelial cells--a state to which the authors refer as residual intestinal disease.

Status of children with cow's milk allergy in infancy by 10 years of age.

UNLABELLED: To assess the development of milk protein tolerance and atopic diseases in children diagnosed for cow's milk allergy (CMA) in infancy, we conducted re-examinations of 56 CMA subjects at the age of 10 y using 204 age-matched controls. The children underwent clinical examinations and skin prick tests (SPT), and their IgE-specific antibodies to milk and five other food allergens were determined. By the age of 10 y, all but four subjects had become tolerant to at least small amounts of milk protein. However, gastrointestinal symptoms relating to more abundant milk consumption were reported by 45% of the study subjects and 15% of the controls (p < 0.001). The incidence figures for asthma, allergic rhinitis and dermatitis, as well as the occurrence of recurrent otitis, were three to four times higher than in the controls. Positive SPTs were seen in two-thirds of the subjects, the figure being highest (83%) in those with dermatitis onset CMA. Seven subjects showed positive titres of IgE-class milk-specific antibodies, and five showed a clinical response. CONCLUSION: This re-examination study showed that CMA in infancy, even when properly treated, has significant clinical consequences by posing special risks for respiratory atopy and persistence of atopic dermatitis as well as positive SPT and recurrent ear infections. However, each of these clinical manifestations seems to have an independent curriculum unrelated to the persistence of CMA itself.

Cow's milk allergy is associated with recurrent otitis media during childhood.

To determine whether cow's milk allergy (CMA) in infancy is associated with recurrent otitis media (ROM) or other chronic ear infections, we conducted a cohort study by enrolling 56 milk-allergic and 204 control schoolchildren. We also studied the association between ear problems and different atopic manifestations. A higher proportion of children with CMA had had ROM. defined as at least 15 acute otitis media episodes by the age of 10 years (27%, vs 12%, p = 0.009), and had undergone adenoidectomy and or tympanostomy compared with the controls (48%, vs 28%, p = 0.005). However, this was only true of the children who had developed respiratory atopy. Asthma and/or allergic rhinitis, but not atopic dermatitis, posed a significant risk for ROM, while all the three atopic manifestations enhanced the risk for secretory otitis media. Positive skin prick tests with food, but not with inhaled allergens, tended to be associated with ear problems. In conclusion, we found that children with CMA in infancy, even when properly treated, had experienced significantly more ROM, the risk associating with concomitant development of respiratory atopy.