[Focal villous atrophy of the duodenum in children who have outgrown cow's milk allergy. Chromoendoscopy and magnification endoscopy evaluation].
Patchy villous atrophy of duodenal mucosa has been described in young children with cow's milk allergy (CMA). Cow's milk protein-sensitive enteropathy may persist in older children and shows characteristic histological features. The advent of magnification endoscopy may allow the macroscopic detection of unrecognised villous atrophy in these patients.


OBJECTIVE
the aim of the study was to evaluate the duodenum mucosa in older children with CM A in infancy using chromoendoscopy and magnification endoscopy.


METHODS
the study involved 15 children (mean age 15 years; range 12-18) with CM A diagnosed and treated in infancy, currently on normal diet, referred to our department due to abdominal pain. The control group consisted of 8 children with abdominal pain without any evidence of allergy (mean age 15 years, range 13-18). In all patients magnification endoscopy and chromoendoscopy was performed under general anaesthesia (GIFQ 160Z, Olympus). The bulb and the descending portion of the duodenum were examined. 1% methylene blue was used for staining. Each endoscopy was recorded on DVD. Patients with celiac disease, after surgery or treated for other disorders were excluded from this part of the investigation.


RESULTS
seven of 15 patients with CM A in infancy had focal villous atrophy of the descending part of the duodenum. In the control group, the villous atrophy was seen in one case.


CONCLUSIONS
1. Magnification endoscopy and chromoendoscopy are a valuable method of detecting focal villous atrophy in patients with suspected food allergy. 2. Focal villous atrophy may indicate the presence of food hypersensitivity of persisting from infancy process.
Jarocka-Cyrta
Elzbieta
E
III Klinika Chorob Dzieci, Akademia Medyczna, ul. Waszyngtona 17, 15-274 Bialystok, Poland. ejarocka@op.pl
Baniukiewicz
Andrzej
A
Wasilewska
Jolanta
J
Pawlak
Joanna
J
Kaczmarski
Maciej
M
D000293:Adolescent; D001284:Atrophy / Q000175:diagnosis / Q000209:etiology; D053704:Capsule Endoscopy; D002648:Child; D004384:Duodenoscopy / Q000379:methods*; D004386:Duodenum / Q000276:immunology / Q000473:pathology* / Q000648:ultrastructure; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007413:Intestinal Mucosa / Q000276:immunology / Q000473:pathology* / Q000648:ultrastructure; D008297:Male; D008751:Methylene Blue; D008871:Microvilli / Q000276:immunology / Q000473:pathology* / Q000648:ultrastructure; D016269:Milk Hypersensitivity / Q000276:immunology / Q000473:pathology*; D008894:Milk Proteins / Q000276:immunology; D012008:Recurrence; D012680:Sensitivity and Specificity; D013194:Staining and Labeling; D014741:Video Recording
D008894:Milk Proteins; D008751:Methylene Blue