Chronic Constipation and Food Hypersensitivity - An Intriguing Relationship

A. Carroccio; G. Iacono

Disclosures

Aliment Pharmacol Ther. 2006;24(9):1295-1304. 

In This Article

Summary and Introduction

Summary

Background: Chronic constipation is common in the general population. Some studies have shown that in children cow's milk protein hypersensitivity can cause chronic constipation unresponsive to laxative treatment.
Aims: To review the literature and summarize the data that point to a relationship between refractory chronic constipation and food hypersensitivity, and to discuss the hypothesis that the pathogenesis of constipation due to food hypersensitivity.
Methods: A search in the U.S. National Library of Medicine was performed, matching the key words 'chronic constipation, food intolerance and allergy'.
Results: Thirty-three papers were found but only 19 of them were related to the topic of this review. Most of the data indicated a relationship between constipation and food allergy in a subgroup of paediatric patients with 'idiopathic' constipation unresponsive to laxative treatment. There was only one study in adults that demonstrated the resolution of chronic constipation on hypoallergenic diet in four patients.
Conclusions: An increasing number of reports suggest a relationship between refractory chronic constipation and food allergy in children. Similar data in adults are scarce and need to be confirmed. Further studies should be performed to obtain firmer evidence for the role of allergy in constipation and clarify the pathogenetic mechanisms involved.

Introduction

Chronic constipation is extremely common in the general population, with a reported prevalence as high as 20%.[1] The disease is also very common in children, the frequency ranging between 3% and 16% of the paediatric population.[2] The role of internists, gastroenterologists or paediatricians is, first of all, to exclude the possibility that the constipation may be secondary to another condition, including cancer of the colon in adults. After this first step, if there are no data indicating secondary constipation a therapeutic trial with fibre and/or simple laxatives is proposed. If further treatment is required, several laxatives at progressively higher dosages can be used. However, this approach does not cure the constipation in a considerable number of patients. In children, indeed, it has been reported that at the end of a 5-year follow-up study, 35–45% of the patients had not recovered.[3] Furthermore, it has been demonstrated that childhood constipation can persist into adulthood, as a recent study showed that one-third of the children followed up beyond puberty continued to have complaints of severe constipation.[4] This finding contradicts the general belief that childhood constipation gradually disappears before or during puberty.

Furthermore, adult patients unresponsive to laxative treatment normally undergo a complete diagnostic study, but very few patients are treated effectively.[1]

Our previous studies have shown that in children with chronic constipation unresponsive to laxative treatment the symptom can be due to cow's milk protein hypersensitivity (CMPH) and in these patients an elimination diet is able to correct the constipation.[5,6]

This review summarizes the literature regarding the relationship between refractory chronic constipation and food hypersensitivity and discusses the hypothesis of the pathogenesis of constipation due to food hypersensitivity.

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