title: Improving tolerability of the ketogenic diet in patients with abnormal endoscopic findings.
abstract: We sought to determine the cause of gastrointestinal (GI) intolerance of a ketogenic diet (KD) using an endoscopic investigation, and to examine the relationship between endoscopic lesions and dietary tolerance. Thirty-five patients were enrolled in this study and underwent gastrofiberscopy prior to initiation of the KD. We observed the relationship between abnormal endoscopic findings and prior use of antiepileptic drugs (AEDs) and symptoms of GI disturbance. We treated patients with GI symptoms, and observed whether the KD was subsequently better tolerated. Of the 35 patients enrolled, 20 patients (57%) had abnormal endoscopic findings: ten cases of erosive gastritis, four of duodenitis, three of hemorrhagic gastritis, two of esophagitis, and one case of duodenal ulcer. The incidence of abnormal endoscopic lesions was 78% in the polypharmacy group (14/35) and 81% in steroid consumers (16/35). Symptoms of GI disturbance, such as nausea, vomiting, unusual irritability, cramping abdominal pain, and diet refusal for over a day, were observed in 17 (85%) of those patients with abnormal endoscopic lesions and in five (33%) patients without such lesions. Steroids and polypharmacy with more than three AEDs were factors associated with abnormal endoscopic lesions (p < 0.05). After active management with GI medications, GI symptoms subsided, and in all cases except one, patients were able to continue the KD treatment. In conclusion, symptoms of GI disturbance were frequently associated with abnormal endoscopic findings prior to initiation of the KD. Active management with GI medications increased the tolerability of the KD in patients treated with multiple AEDs and steroids.
authors.affiliation: Department of Pediatrics, Pediatric Epilepsy Clinic, Severance Children's Hospital, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors.forename: Da Eun
authors.initials: DE
authors.lastname: Jung
authors.forename: Ju Young
authors.initials: JY
authors.lastname: Chung
authors.forename: Hoon-Chul
authors.initials: HC
authors.lastname: Kang
authors.forename: Heung Dong
authors.initials: HD
authors.lastname: Kim
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004041:Dietary Fats / Q000008:administration & dosage*; D020776:Endoscopes, Gastrointestinal; D004827:Epilepsy / Q000178:diet therapy* / Q000188:drug therapy; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000473:pathology*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies
chemical_list: D000927:Anticonvulsants; D004041:Dietary Fats