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DOI: 10.1055/s-0037-1617940
Chronische Diarrhö bei Nahrungsmittelunverträglichkeiten
Chronic diarrhoea and food intolerancesPublication History
Eingegangen:
10 October 2006
angenommen:
27 October 2006
Publication Date:
11 January 2018 (online)
Zusammenfassung
Bei Kindern aus Industrienationen ist die häufigste Ursache einer chronischen Diarrhö eine Nahrungsmittelunverträglichkeit, die entweder ein Protein (immunmediierte Nahrungsmittelunverträglichkeit, z. B. bei Zöliakie) oder ein Kohlenhydrat (nicht-immunmediierte Nahrungsmittelunverträglichkeit, z. B. bei Fruktosemalabsorption) betrifft. Die klinische Präsentation kann vielgestaltig sein, wesentliche Folgen der chronischen Diarrhö sind aber Gedeihstörung und Malnutrition. Zur Diagnostik gehören Symptomprotokolle sowie spezifische nicht-invasive (z. B. serologische Zöliakietests) wie auch invasive Untersuchungen (z.B. Endoskopie mit histologischer Analyse). Die Therapie ist diätetisch und die Langzeitprognose bei adäquat eingehaltener Diät in der Regel gut.
Summary
The most frequent cause of chronic diarrhoea in children of western countries is a food intolerance, either concerning a protein (immun-mediated, i. e. celiac disease) or a carbohydrate (non-immun-mediated, i. e. fructose malabsorption). Clinical presentation may be variable, but main sequelae of chronic diarrhoea are failure to thrive and malnutrition. Diagnostic work up includes symptom protocols as well as specific non-invasive (i. e. serological celiac tests) and invasive investigations (i. e. endoscopy with histological examination). Treatment is based on dietary intervention with an excellent prognosis if followed closely.
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Literatur
- 1 Aardoom HA, Hirasing RA, Rona RJ. et al. Food intolerance (food hypersensitivity) and chronic complaints in children: the parents’ perception. Eur J Pediatr 1997; 156: 110-2.
- 2 Baldassano RN, Baldassano RN, Liacouras CA. Chronic diarrhea. A practical approach for the pediatrician. Pediatr Clin North Am 1991; 38: 667-86.
- 3 Benahmed M, Mention JJ, Matysiak-Budnik T, Cerf-Bensussan N. Celiac disease: a future without gluten-free diet?. Gastroenterology 2003; 125: 1264-7.
- 4 Ciclitira PJ, King AL, Fraser JS. AGA technical review on Celiac Sprue. American Gastroenterological Association. Gastroenterology 2001; 120: 1526-40.
- 5 Collin P, Kaukinen K, Vogelsang H. et al. Antiendomysial and antihuman recombinant tissue transglutaminase antibodies in the diagnosis of coeliac disease: a biopsy-proven European multicentre study. Eur J Gastroenterol Hepatol 2005; 17: 85-91.
- 6 Collin P, Maki M, Kaukinen K. Complete small intestine mucosal recovery is obtainable in the treatment of celiac disease. Gastrointest Endosc 2004; 59: 158-9.
- 7 Dieterich W, Laag E, Schopper H. et al. Autoantibodies to tissue transglutaminase as predictors of celiac disease. Gastroenterology 1998; 115: 1317-21.
- 8 Dube C, Rostom A, Sy R. et al. The prevalence of celiac disease in average-risk and at-risk Western European populations: a systematic review. Gastroenterology 2005; 128: 57-67.
- 9 Enattah NS, Sahi T, Savilahti E. et al. Identification of a variant associated with adult-type hypolactasia. Nat Genet 2002; 30: 233-7.
- 10 Farrell RJ, Kelly CP. Celiac sprue. N Engl J Med 2002; 346: 180-8.
- 11 Fasano A. Celiac disease – how to handle a clinical chameleon. N Engl J Med 2003; 348: 2568-70.
- 12 Fontaine JL, Navarro J. Small intestinal biopsy in cow’s milk protein allergy in infancy. Arch Dis Child 1975; 50: 357-62.
- 13 Guarino A, Spagnuolo MI, Russo S. et al. Etiology and risk factors of severe and protracted diarrhea. J Pediatr Gastroenterol Nutr 1995; 20: 173-8.
- 14 Hauer AC, Breese EJ, Walker-Smith JA, MacDonald TT. The frequency of cells secreting interferon-gamma and interleukin-4, -5, and -10 in the blood and duodenal mucosa of children with cow’s milk hypersensitivity. Pediatr Res 1997; 42: 629-38.
- 15 Hausch F, Shan L, Santiago NA. et al. Intestinal digestive resistance of immunodominant gliadin peptides. Am J Physiol Gastrointest Liver Physiol 2002; 283: 996-1003.
- 16 Heitlinger LA, Lebenthal E. Disorders of carbohydrate digestion and absorption. Pediatr Clin North Am 1988; 35: 239-55.
- 17 Hoekstra JH, van den Aker JH, Hartemink R, Kneepkens CM. Fruit juice malabsorption: not only fructose. Acta Paediatr 1995; 84: 1241-4.
- 18 Hoekstra JH, van den Aker JH, Ghoss YF. et al. Fluid intake and industrial processing in apple juice induced chronic non-specific diarrhoea. Arch Dis Child 1995; 73: 126-30.
- 19 Imanzadeh F, Sayyari AA, Yaghoobi M. et al. Celiac disease in children with diarrhea is more frequent than previously suspected. J Pediatr Gastroenterol Nutr 2005; 40: 309-11.
- 20 Issenman RM, Hewson S, Pirhonen D. et al. Are chronic digestive complaints the result of abnormal dietary patterns? Diet and digestive complaints in children at 22 and 40 months of age. Am J Dis Child 1987; 141: 679-82.
- 21 Johansson SG, Hourihane JO, Bousquet J. et al. A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy 2001; 56: 813-24.
- 22 Kalach N, Soulaines P, de Boissieu D. A pilot study of the usefulness and safety of a ready-to-use atopy patch test (Diallertest) versus a comparator (Finn Chamber) during cow’s milk allergy in children. J Allergy Clin Immunol 2005; 116: 1321-6.
- 23 Lifshitz F, Ament ME, Kleinman RE. et al. Role of juice carbohydrate malabsorption in chronic nonspecific diarrhea in children. J Pediatr 1992; 120: 825-9.
- 24 Marsh MN. Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity (‘celiac sprue’). Gastroenterology 1992; 102: 330-54.
- 25 Moukarzel AA, Lesicka H, Ament ME. Irritable bowel syndrome and nonspecific diarrhea in infancy and childhood – relationship with juice carbohydrate malabsorption. Clin Pediatr (Phila) 2002; 41: 145-50.
- 26 Obermayer-Pietsch BM, Bonelli CM. Genetic predisposition for adult lactose intolerance and relation to diet, bone density, and bone fractures. J Bone Miner Res 2004; 19: 42-7.
- 27 Rasinpera H, Savilahti E, Enattah NS. et al. A genetic test which can be used to diagnose adult-type hypolactasia in children. Gut 2004; 53: 1571-6.
- 28 Rings EH, Grand RJ, Buller HA. Lactose intolerance and lactase deficiency in children. Current Opin Pediatric 1994; 6: 562-7.
- 29 Rona RJ, Chinn S. Parents’ perceptions of food intolerance in primary school children. Br Med J (Clin Res Ed) 1987; 294: 863-6.
- 30 Shan L, Molberg O, Parrot I. et al. Structural basis for gluten intolerance in celiac sprue. Science 2002; 297: 2275-9.
- 31 Sicherer SH. Clinical aspects of gastrointestinal food allergy in childhood. Pediatrics 2003; 111: 1609-16.
- 32 Steens RF, Csizmadia CG, George EK. et al. A national prospective study on childhood celiac disease in the Netherlands 1993–2000: an increasing recognition and a changing clinical picture. J Pediatr 2005; 147: 239-43.
- 33 van Bockel-Geelkerken M, Meulmeester JF. Prevalence of putative food hypersensitivity in young children. Ned Tijdschr Geneeskd 1992; 136: 1351-6.
- 34 Veligati LN, Treem WR, Sullivan B. et al. Delta 10 ppm versus delta 20 ppm: a reappraisal of diagnostic criteria for breath hydrogen testing in children. Am J Gastroenterol 1994; 89: 758-61.
- 35 Ventura A, Facchini S, Amantidu C. et al. Searching for celiac disease in pediatric general practice. Clin Pediatr (Phila) 2001; 40: 575-7.
- 36 Walker-Smith JA. Diagnostic criteria for coeliac disease and transient gluten intolerance. Lancet 1980; 1: 926.
- 37 Walker-Smith JA. Toddler’s diarrhoea. Arch Dis Child 1980; 55: 329-30.
- 38 Wasserman D, Hoekstra JH, Tolia V. et al. Molecular analysis of the fructose transporter gene (GLUT5) in isolated fructose malabsorption. J Clin Invest 1996; 98: 2398-402.
- 39 Zeiger RS. Dietary aspects of food allergy prevention in infants and children. J Pediatr Gastroenterol Nutr 2000; 30: 77-86.
- 40 Zuberbier T, Edenharter G, Worm M. Prevalence of adverse reactions to food in Germany – a population study. Allergy 2004; 59: 338-45.