title: The significance of gastric juice analysis for a positive challenge by a standard oral challenge test in typical cow's milk protein-induced enterocolitis.
abstract: This study was performed to investigate the significance of gastric juice analysis (GJA) as a diagnostic criterion of a positive challenge in a standard oral cow's milk challenge (OCC) to confirm typical cow's milk protein-induced enterocolitis (CMPIE). Data from 16 CMPIE patients (aged 14 to 44 days) were analyzed. A standard OCC was openly executed using 0.15 g/kg of protein. Three symptoms (vomiting, lethargy, and bloody or pus-like stool), and four laboratory findings (GJA [3 hr], changes in peripheral blood absolute neutrophil count [ANC] [6 hr], C-reactive protein [6 hr], and stool smear test for occult blood or leukocytes) were observed after OCC. Before OCC, baseline studies were conducted; a stool smear test, blood sampling, and GJA. Positive OCC results were; vomiting (87.5%) (observed 1-3 hr after OCC), lethargy (62.5%) (1-3 hr), bloody or pus-like stool (43.8%) (6-10 hr), abnormal GJA (93.8%), an ANC rise >3,500 cells/microL (93.8%), and an abnormal stool smear test (75.0%). A single GJA test after a standard OCC is a sensitive diagnostic criterion of a positive challenge, and may provide an early confirmatory diagnosis of CMPIE. An investigation of positive OCC outcomes helps to find out a diagnostic algorithm of criteria of a positive challenge in CMPIE.
authors.affiliation: Department of Pediatrics, Institute for Medical Science, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea. pedgi@kmu.ac.kr
authors.forename: Jin-Bok
authors.initials: JB
authors.lastname: Hwang
authors.forename: Jeong-Yoon
authors.initials: JY
authors.lastname: Song
authors.forename: Yu Na
authors.initials: YN
authors.lastname: Kang
authors.forename: Sang Pyo
authors.initials: SP
authors.lastname: Kim
authors.forename: Seong-Il
authors.initials: SI
authors.lastname: Suh
authors.forename: Sin
authors.initials: S
authors.lastname: Kam
authors.forename: Won Joung
authors.initials: WJ
authors.lastname: Choi
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D000818:Animals; D001772:Blood Cell Count; D002097:C-Reactive Protein / Q000032:analysis; D002417:Cattle; D004760:Enterocolitis / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D005750:Gastric Juice; D006801:Humans; D008297:Male; D016269:Milk Hypersensitivity / Q000175:diagnosis* / Q000473:pathology*; D008894:Milk Proteins / Q000032:analysis*; D009504:Neutrophils / Q000166:cytology
chemical_list: D008894:Milk Proteins; D002097:C-Reactive Protein