CLINICAL CONFERENCE

Dr. Levine: The patient to be presented is an infant who had chronic diarrhea. Studies performed on this patient by Dr. Murray Davidson, Assistant Professor of Clinical Pediatrics, suggest that there are multiple factors involved in the production of the celiac syndrome. Dr. Davidson will discuss the patient's illness and observations made. Dr. Murray Davidson: To many pediatricians the diagnosis of celiac syndrome means difficulty in absorption of nutrients. According to this concept the diagnosis cannot be made unless there is evidence of excessive stool loss of ingested material. An important contribution to our understanding of the condition has been made by the Dutch and British workers who have demonstrated steatorrhea related to the ingestion of gluten in patients with the celiac syndrome. On the other hand, to some, celiac syndrome merely implies a state of chronic diarrhea. Thus, some cases of diarrhea related to milk ingestion have been called celiac syndrome because of chronicity of symptoms. To the best of our knowledge there are no published reports of such patients in whom detailed study has revealed evidence of malabsorption or a relationship to a specific protein in milk as has been shown in the studies with gluten. In this paper it is our intention first to report a patient who fulfilled the criteria for celiac syndrome upon ingestion of a specific milk protein, and then to examine the current classification of the conditions which make up the celiac syndrome. D.B., a 5-week-old infant, was admitted to the New York Hospital with a history of severe and chronic diarrhea from birth, manifested while receiving evaporated and skim milk formulae as well as Nutramigen®. Stool cultures failed to reveal any pathogens. Study of the urinary tract, gastrointestinal tract and adrenal function revealed no cause for diarrhea.