title: Food intolerance and chronic constipation: manometry and histology study.
abstract: BACKGROUND
  Chronic constipation in children can be caused by cows' milk intolerance (CMI), but its pathogenesis is unknown.
  
  
  OBJECTIVE
  To evaluate the histology and manometry pattern in patients with food intolerance-related constipation.
  
  
  METHODS
  Thirty-six consecutive children with chronic constipation were enrolled. All underwent an elimination diet and successive double-blind food challenge. All underwent rectal biopsy and anorectal manometry.
  
  
  RESULTS
  A total of 14 patients were found to be suffering from CMI and three from multiple food intolerance. They had a normal stool frequency on elimination diet, whereas constipation recurred on food challenge. The patients with food intolerance showed a significantly higher frequency of erosions of the mucosa, and the number of intra-epithelial lymphocytes and eosinophils. The rectal mucous gel layer showed that the food-intolerant patients had a significantly lower thickness of mucus than the other subjects studied. Manometry showed a higher anal sphincter resting pressure and a lower critical volume in food intolerance patients than in the others suffering from constipation unrelated to food intolerance. Both histology and manometry abnormalities disappeared on the elimination diet.
  
  
  CONCLUSIONS
  Food intolerance-related constipation is characterized by proctitis. Increased anal resting pressure and a reduced mucous gel layer can be considered to be contributory factors in the pathogenesis of constipation.
authors.affiliation: Department of Paediatric Gastroenterology, Di Cristina Hospital, Palermo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Iacono
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Bonventre
authors.forename: Calogero
authors.initials: C
authors.lastname: Scalici
authors.forename: Emiliano
authors.initials: E
authors.lastname: Maresi
authors.forename: Lidia
authors.initials: L
authors.lastname: Di Prima
authors.forename: Maurizio
authors.initials: M
authors.lastname: Soresi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Gesù
authors.forename: Davide
authors.initials: D
authors.lastname: Noto
authors.forename: Antonio
authors.initials: A
authors.lastname: Carroccio
mesh_terms: D001003:Anal Canal / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003248:Constipation / Q000178:diet therapy / Q000209:etiology* / Q000473:pathology; D003672:Defecation; D004311:Double-Blind Method; D005260:Female; D005512:Food Hypersensitivity / Q000150:complications* / Q000178:diet therapy / Q000473:pathology; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008365:Manometry; D016269:Milk Hypersensitivity / Q000150:complications / Q000178:diet therapy / Q000473:pathology; D011349:Proctitis / Q000150:complications / Q000473:pathology; D012007:Rectum / Q000473:pathology