COWS MILK PROTEIN-SENSITIVE ENTEROPATHY - IMPORTANT CONTRIBUTING CAUSE OF SECONDARY SUGAR INTOLERANCE IN YOUNG INFANTS WITH ACUTE INFECTIVE ENTERITIS

Secondary sugar intolerance is a well recognised and common complication of acute infective enteritis (AIE) in young infants. The intolerance appears to be due to depletion of mucosal sugar-splitting enzymes secondary to damage to the small bowel mucosa caused by the primary infective agent. Exclusion of this sugar, however, does not always effect the diarrhoea. Recently cows' milk protein sensitive enteropathy (CMPSE) was shown to be an important factor prolonging diarrhoea in young infants with AIE. The effect of cows' milk protein (CMP) on the mucosal disaccharidases was investigated in 23 infants with acute infective enteritis. Jejunal biopsies performed before and after cows' milk provocation were subjected to histological examination and to mucosal disaccharidase enzyme (lactase, sucrase, and maltase) analyses. After milk challenge, changes in mucosal histology were observed in 18 infants; in 17 of them the levels of all 3 mucosal disaccharidases were much reduced. 10 of these infants developed diarrhoea and, in 6, the stools were positive for reducing sugar. It is concluded that CMP has a deleterious effect on the jejunal mucosa of young infants recovering from infective enteritis, so that in the management of young infants with sugar intolerance secondary to infective enteritis, CMP and lactose should be excluded from the diet.