Objective: To evaluate the prevalence of chronic constipation (CC) in unselected children, its association with atopy, and the efficacy of a cow's milk protein (CMP) elimination diet on refractory constipation.
Study Design: The study was conducted by 6 primary care pediatricians, serving a population of 5113 children aged birth through 12 years, but only 2068 of them were 6 months-6 years. During a three month period, prevalence of CC was determined for the entire study population, ages 0-12 years. In the second part of the study, all patients aged 6 months to 6 years with chronic constipation, and age and sex matched controls, were evaluated for atopy. and its association with CC. A questionnaire was completed including personal and family history of atopy and bowel movement characteristics. Patients were tested for atopy by specific serum IgE and/or skin-prick tests. Constipated patients, refractory to osmotic laxatives, underwent a 4-week CMP elimination diet.
Results: 91 (1.8 %) had CC, and 69 (3.3%) of the 6 months-6 years age-group fell into the atopy study age range. All 69 constipated children (mean age + SD: 34.9 + 18.0 months) and 69 controls completed the questionnaire. Twelve of 69 constipated children (17.3 %) and 13 of 69 control children (18.8 %) had a diagnosis of atopy. Eleven of 69 (15.9%) constipated children were refractory to constipation treatment, and 3 (27.3%) of these had atopy. The 4 week trial of dietary elimination did not result in improvement in any of these 11 children.
Conclusions: In our study group, prevalence of atopy among children with CC is similar to that in the general population. Refractoriness of chronic constipation does not seem to be related to cow's milk allergy.