“Dietery Intervention as a Therapy for Behaviour Problems in Children with Gastrointestinal Allergy” Dr Widodo Judarwanto Judarwanto SpA, Klinik Alergi Anak, Rumah Sakit Bunda Jakarta, Klinik Biomedis Gangguan Perkembangan & Perilaku, Children Family Clinic Jakarta Email :
[email protected], (021) 31922005, 4264126, 70081995, 0817171764
Abstrak This brief study describes the reports of parents of dietery intervention as a therapy for 50 children with gastroenterointestinal symptom in food allergy. All of whom have been utilising a programme involving the exclusion of allergies foods from the diet an to evaluate of behaviour problem in children under 2 years old. Method The parents of 91 children with gastrointestinal allergy (aged 0 months to 2 years) who were utilising this form of dietary intervention and who were prepared to be interviewed were recruited. Diagnosis of CMA was based upon clinical criteria described by Goldman and measuring of total Ig E. The majority of the subjects were collect at Children Allergy Center Bunda Hospital jakarta on February 1, 2003 untill June 31, 2003. Evaluation of clinical course done at 3rd weeks and 4th weeks after dieteary intervention. All parents had, by the time of interview, removed food allergy containing products from the diet with Rowe diets and evaluated for sleep patterns, aggressive, tantrum hyperactivity, socialize, enuresis, emotional and speech. Results The parents of all 50 subjects were aware of behaviour problems before the official diagnosis was made. All parents had, by the time of interview, removed food allergy containing products from the diet with Rowe diets. Fourty children excluded of this study because had been infection, need some oral medicine and drop out. Evaluation of clinical course done at 3rd weeks and 4th weeks after dieteary intervention for 50 children. All parents had, by the time of interview, removed food allergy containing products from the diet with Rowe diets and evaluated for sleep patterns, aggressive, tantrum hyperactivity, socialize, emotional, inattention, self injury and speech development. Conclusion Quite clearly this stydy can only be of a preliminary nature in behaviour problem in children with gastroenterointestinal allergy. Dietary intervention seems plays an important role in the management of certain that behaviour disorders. All Rights Reserved - www.puterakembara.org - 2013
Behaviour problem in children with systemic features particularly with gastroenterointestinal allergy may be approached from a complementary medicine model that recognizes the role of the abdominal nervous system with regard to etiology and treatment.
Pendahuluan Terdapat suatu bidang penelitian baru dalam aspek psikneuroimunologi, yaitu penelitian yang mengungkapkan bagaimana system imun dan system susunan saraf pusat saling bergubungan dalam mempengaruhi kesehatan manusia.. Pada penelitian terakhir didapatkan bahwa alergi dapat mempengaruhi berbagai system tubuh termasuk otak. Gejala gastrointestinal pada alergi makanan dapat dijelaskan karena adanya perubahan sistem transport pada dinding saluran cerna (peningkatan skretori dan penurunan fungsi absorpsi), peningkatan permeabilizas dan motilitas dari saluran cerna. Cara dan metoda Dilakukan observasi 91 anak yang mendapat perawatan di klinik Alergi Anak Rumah Sakit Bunda Jakarta dengan alergi gastrointestinal yang berusia 0 bulan hingga 2 tahun, pada tanggal 1 Februari 2003 hingga 31 Juni 2003. Telah dilakukan wawancara terhadap orang tua dan diberikan petunjuk sesuai formulir isian yang diberikan terhadap intervensi diet yang akan diberikan pada anaknya. Diagnosis alergi gastrointestinal ditegakkan berdasarkan kriteria klinis modifikasi Goldman dan pengukuran IgE total. Dilakukan intervensi diet terhadap semua penderita dan dilakukan evaluasi klinis saat minggu ke III dan minggu ke IV. Intervensi diet yang dilakukan adalah penghindaran sementara makanan tertentu sesuai modifikasi Diet Rowes. Adapun yang dihindari adalah susu sapi, buah-buahan tertentu, telor, ayam, ikan dan kacang-kacangan. Evaluasi dengan melakukan pemeriksaan fisik dan wawancara terhadap orang tua terhadap gejala gangguan saluran cerna dan perilaku pada anak seperti gangguan tidur, agresifitas, tantrum, enuresis, dan gangguan bicara. Hasil dan Diskusi Dari 91 anak akhirnya didapatkan 50 anak yang dapat masuk dalam penelitian, 41 anak dikeluarkan karena minum obat-obatan, melanggar intervensi diet, sakit dan tidak control lagi..
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Table 1. Karakteristik riwayat manifestasi klinis alergi Manifestasi klinis
Dermatitis Rhinitis Batuk lama Wheezing Manifestasi Gastrointestinal Diare Konstipasi Muntah Droolong/sialore Mulut berbau GER Gangguan kenaikkan berat badan Status Gizi Malnutrisi Gizi baik Overweight/obesitas
n(%)
48(96%) 38(76%) 6(12%) 4(8%) 50(100%) 28(64%) 22(44%) 24(48%) 22(44%) 19(38%) 18(36%) 36(76%) 23(66%) 10(20%) 17(34%)
Manifestasi klinis yang ditemukan adalah dermatitis 48(96%), rhinitis 38(76%), batuk lama 6(12%) dan wheezing 4(4%). Sedangkan manifestasi gangguan saluran cerna yang didapatkan adalah diare 28(64%), konstipasi 22(44%), muntah 24(48%), sialore /”ngiler” 22(44%), mulut berbau 19(38%) dan GER 19(36%). Penderita dermatitis sebanyak 96% pada penderita alergi gastrointestinal menunjukkan bahwa tampaknya terdapat hubungan antara gangguan saluran cerna dan dermatitis. Selain gangguan target langsung dari proses alergi terhadap kulit dan saluran cerna, diduga terdapat gangguan metabolisme sulfat pada penderita gangguan saluran cerna. Gangguan metabolisme sulfur tersebut menghasilkan sulfit yang dapat menggganggu gangguan kulit berupa dermatitis. Didapatkan 36 (76%) anak dengan gangguan kenaikan berat badan, sedangkan status gizi yang didapatkan adalah malnutrisi 23(66%), gizi baik 10 (20%) dan kelebihan berat badan dan obesitas sebanyak 17 (24%) anak.
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Table 2. Karakteristik gangguan perkembangan dan perilaku Gangguan perkembangan dan perilaku
n(%)
Kesulitan makan Gangguan perkembangan bicara MSDD/Autism Enuresis Aggresif Sosialisasi Tantrum Gangguan tidur Hyperactive/impulsive Inattention Melukai diri sendiri
38(76%) 11(22%) 4(8%) 15(33%) 34(68%) 5(10%) 18(36%) 44(88%) 38(76%) 4(8%) 15(32%)
Evaluasi klinis terhadap manifestasi gangguan saluran cerna dan gangguan perilaku pada anak dilakukan pada minggu ke III dan minggu ke IV setelah dilakukan intervensi diet.
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Table 3. Evaluasi manifetstasi klinis gejala alergi pada minggu ke IV
Manifestasi klinis
minggu ke III membaik/tidak membaik n(%)
minggu ke IV membaik/tidak membaik n(%)
Dermatitis 44(92%)/4(8%) Rhinitis 25(66%)/9(34%) Batuk lama 12(86%)/2(14%) Rhinitis alergi 3(75%)/1(25%) Gejala gangguan saluran cerna Manifestasi Gastrointestinal Diare 28(100%)/0(0%) Konstipasi 16(72%)/6(28%) Muntah 21(92%)/1(8%) Droolong/sialore 17(76%)/5(24%) Mulut berbau 19(100%)/0(0%) GER 10(58%)/8(42%)
47(98%)/1(2%) 29(76%)/5(14%) 14(100%)/0(0%) 3(75%)/1(25%)
28(100%)/0(0%) 20(91%)/2(9%) 22(100%)/0(0%) 21(92%)/1(8%) 19(100%)/0(0%) 15(83%)/3(17%)
Table 4. Evaluasi gangguan perilaku pada minggu ke III dan minggu ke IV Manifestation
Eating difficulties 6(16%) Speech delay 6(55% Aggressive 4(12%) Less Socialitation 2(40%) Tantrum 7(39%) Sleep disturbance 1(2%)
Minggu ke III Membaik/ tidak membaik n(%)
Minggu ke IV Membaik/ tidak membaik n(%)
30(79%)
8(21%)
3(27%)
8(73%)
5(45%)
28(82%)
6(18%)
30(88%)
2(40%) 6(33%) 40(91%)
32(84%)
3(60%)
3(60%)
12(67%)
11(61%)
4(9%)
43(98%)
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Hyperactive/impulsive 14(37%) Inattention 1(25%) Self Injury 4(25%)
18(47%)
20(53%)
24(63%)
2(50%)
2(50%)
3(75%)
10(66%)
5(33%)
12(75%)
Kesimpulan Penelitian tersebut sebagai penelitian awal untuk mengungkapkan secara lebih jelas hubungan antara perilaku anak dan gangguan saluran cerna karena alergi. Intervensi diet alergi tampaknya berperanan sangat penting dalam penanganan gangguan perkembangan dan perilaku pada anak.
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