Portal de Periódicos da CAPES

Lymphonodular Hyperplasia as a Sign of Food Allergy in Children

2000; Lippincott Williams & Wilkins; Volume: 30; Issue: 3 Linguagem: Inglês

10.1097/00005176-200003000-00032

1536-4801

Lucrecia Suárez Cortina, Amaya Bélanger-Quintana,

Gastrointestinal disorders and treatments

To the Editor: About the time the article “Lymphonodular Hyperplasia as a Sign of Food Allergy in Children” by Kokkonen et al. (J Pediatr Gastroenterol Nutr 1999;29:57–62) was published, we had two cases with similar endoscopic and histologic findings. Our cases involved two girls, one 2 years and one 14 months of age. Both were brought for consultation because of poor weight gain with no other abdominal symptoms. Because they were positive for anti-gliadin and anti-endomysium antibodies, they were scheduled for an endoscopy. Duodenal biopsy specimens of the younger girl showed subtotal villous atrophy, supporting the possibility of celiac disease that will have to be confirmed in the future. The other girl had normal villi. What was surprising was to find lymphonodular hyperplasia in the duodenal bulb of both girls. The visual finding was corroborated by biopsy specimens obtained in the affected area. Although Kokkonen et al. encountered a duodenal bulb frequently (12 out of 63 children), in our series of approximately 140 to 150 endoscopies per year in the past 20 years, it is the first time we have seen such an image. We do not believe we have overlooked this finding in our endoscopies because, when present, it is very evident. The literature on intestinal lymphonodular hyperplasia usually refers to its more frequent location in the colon or ileum (1), but there is little said about the duodenal bulb. This is probably related to a smaller prevalence of these pathologic findings than that stated by the authors. We cannot explain why we had never seen an image similar to these and then in 1 month had two similar cases. Is the incidence growing in our population? We cannot yet answer this question. As for the reason for the lymphonodular hyperplasia, we do not believe food allergy is the only, or even the main, causative agent. Our patients had no signs or symptoms of food allergy. In one girl, celiac disease seems to be a plausible diagnosis. Brocchi et al. (2) have described duodenal bulb micronodules in a patient with celiac disease. We believe duodenal bulb lymphonodular hyperplasia is a pathologic finding that should prompt further studies to diagnose the cause of aggression into the intestinal tissue. A wide range of aggressive agents, including parasites, celiac disease, and an allergic response to various foodstuffs, should be evaluated. Lucrecia Suárez Cortina Amaya Bélanger-Quintana