J Korean Med Sci.  2008 Apr;23(2):251-255. 10.3346/jkms.2008.23.2.251.

The Significance of Gastric Juice Analysis for a Positive Challenge by a Standard Oral Challenge Test in Typical Cow's Milk Protein-Induced Enterocolitis

• Hwang JB
• Song JY
• Kang YN
• Kim SP
• Suh SI
• Kam S
• Choi WJ

• KMID: 1713457
• DOI: http://doi.org/10.3346/jkms.2008.23.2.251

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/microliter (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.

Keyword

Food Hypersensitivity; Cow's Milk Protein-Induced Enterocolitis; Oral Challenge; Diagnostic Criteria; Gastric Juice Analysis

MeSH Terms

Adolescent
Adult
Algorithms
Animals
Blood Cell Count
C-Reactive Protein/analysis
Cattle
Enterocolitis/*diagnosis/*etiology
Female
*Gastric Juice
Humans
Male
Milk Hypersensitivity/*diagnosis/*pathology
Milk Proteins/*analysis
Neutrophils/cytology

Figure

• 

  Fig. 1 Results of the early phase diagnosis* evaluated with 3 parameters composed of vomiting, lethargy, and gastric juice analysis (GJA) in typical cow's milk protein-induced enterocolitis (CMPIE). *, When either vomiting and lethargy or GJA was positive within 4 hr after oral cow's milk challenge, we defined it as the early phase diagnosis.

• 

  Fig. 2 Algorithm after oral cow's milk challenge for the diagnosis* of typical cow's milk protein-induced enterocolitis. *, We defined a positive challenge as the presence of two or more positive results of the six parameters and the early phase† diagnosis as a diagnosis made within 4 hr of an oral cow's milk challenge using the early phase diagnostic criteria defined as when either vomiting and lethargy or gastric juice analysis was positive. ANC, absolute neutrophil count.

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