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Gastrointestinal findings in atopic children

Abstract

36 children aged 0.13 to 13.05 years with severe manifestations of atopy were studied for circulating parietal cell antibodies (PCA), fasting serum gastrin and ferritin. Gastric acid secretion was measured using a pentagastrin test. In addition, 21 gastric and 28 jejunal biopsies were taken for evaluation of the mucosal morphology. In infants the gastric secretion studies were repeated after a three month hypoallergic diet.

Maximal acid output (MAO) was significantly (P<0.01) diminished in atopic infants under one year of age. In this group one girl with transient PCA was achlorhydric and seven others were hypochlorhydric, as compared with controls of the same age. Acid secretion returned to normal in most children while on the elimination diet, and only two remained hypochlorhydric thereafter. The picture was more complex in the older children as some continued to exhibit hyposecretion in their second year of life, while others were even hyperchlorhydric. Epithelial degeneration, found in 13 out of the 21 samples, was the most striking feature in the gastric biopsies. Jejunal biopsies revealed increased eosinophilic infiltration of the lamina propria in 10 out of 28 diagnostic samples; two had slight and another two partial villous atrophy.

It is concluded that in atopic children gastric hyposecretion and epithelial degeneration may promote the passage of unhandled food allergens through the jejunal mucosa, predisposing to more severe changes, as seen in cow's milk intolerance. Slight villous atrophy with eosinophilic infiltration and oedema of the lamina propria may cause mild absorption defects, growth and nutritional deficiencies in these children. Atopy should be considered as a possible aetiological factor in prolonged gastrointestinal disorders in infants.

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References

  1. 1.

    Brandtzaeg P, Baklien K (1976) Immunoglobulin-producing cells in the intestine in health and disease. Clin Gastroenterol 5:251–269

  2. 2.

    Buckley RH, Dees SC (1969) Correlation of milk precipitins with IgA deficiency. N Engl J Med 281:464–469

  3. 3.

    Burgio GR, Nespoli L, Ugazio AG (1978) Atopy as a minimal immunodeficiency? Eur J Pediatr 129:221–229

  4. 4.

    Caldwell JH, Tennenbaum JI, Bronstein HA (1975) Serum IgE in eosinophilic gastroenteritis. Response to intestinal challenge in two cases. N Engl J Med 292:1388–1390

  5. 5.

    Card WI, Marks IN (1960) The relationship between the acid output of the stomach following “maximal” histamine stimulation and the parietal cell mass. Clin Sci 19:147–163

  6. 6.

    Ferguson A (1976) Celiac disease and gastrointestinal food allergy. In: Ferguson A, MacSween RNM (eds) Immunological aspects of the liver and gastrointestinal tract. MTP, Lancaster England, pp 153–202

  7. 7.

    Giannella, RA, Broitman SA, Zamcheck N (1972) Gastric acid barrier to ingested micro-organisms in man: studies in vivo and in vitro. Gut 13:251–256

  8. 8.

    Jarret E (1977) Activation of IgE regulatory mechanisms by transmucosal absorption of antigen. Lancet II:223–225

  9. 9.

    Katz, AJ, Goldman H, Grand RJ (1977) Gastric mucosal biopsy in eosinophilic (allergic) gastroenteritis. Gastroenterology 73:705–709

  10. 10.

    Kokkonen J, Similä S, Herva R (1979) Impaired gastric function in children with cow's milk intolerance. Eur J Pediatr 132:1–6

  11. 11.

    Kuitunen P (1966) Duodeno-jejunal histology in malabsorption syndrome in infants. Ann Paediatr Fenn 12:101–132

  12. 12.

    Kuitunen P, Visakorpi JK, Savilahti E, Pelkonen P (1975) Malabsorption syndrome with cow's milk intolerance. Clinical findings and course in 54 cases. Arch Dis Child 50: 351–356

  13. 13.

    Matthew DJ, Taylor B, Norman AP, Turner MW, Soothill JF (1977) Prevention of exzema. Lancet I:321–324

  14. 14.

    Orgel HA, Hamburger KN, Bazaral M, Gorrin H, Groshong T, Lenoir M, Miller JR, Wallace W (1975) Development of IgE and allergy in infancy. J Allergy Clin Immunol 56: 296–307

  15. 15.

    Pepys J (1975) Atopy. In: Gell PGH, Coombs RRA, Lachman PJ (eds) Clinical aspects of immunology. Blackwell. Oxford England, pp 887–902

  16. 16.

    Shiner M, Ballard J, Brook CGD et al. (1975) Intestinal biopsy in the diagnosis of cow's milk intolerance without acute symptoms. Lancet II:1060–1063

  17. 17.

    Siimes MA, Addiego JE, Dallman PR (1974) Ferritin in serum. Diagnosis of iron deficiency and iron overload in infants and children. Blood 43:581–584

  18. 18.

    Strannegård Ö, Strannegård I-L, Juto P (1978) Pathogenesis of atopic allergy. Lancet II:385–386

  19. 19.

    Taylor B, Norman AP, Orgel HA, Stokes GR, Turner MW, Soothill JF (1973) Transient IgA deficiency and pathogenesis of infantile atopy. Lancet II:111–113

  20. 20.

    Walker WA (1978) Antigen handling by the gut. Arch Dis Child 53:527–531

  21. 21.

    Whitehead R (1973) Mucosal biopsy of the gastrointestinal tract. Saunders, London

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Correspondence to J. Kokkonen.

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Kokkonen, J., Similä, S. & Herva, R. Gastrointestinal findings in atopic children. Eur J Pediatr 134, 249–254 (1980). https://doi.org/10.1007/BF00441481

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Key words

  • Gastric juice
  • Gastric mucosa
  • Food hypersensitivity
  • Jejunal mucosa