title: Differentiation of cows' milk intolerance and gastro-oesophageal reflux.
abstract: The aim of this study was to compare a non-invasive test of small bowel permeability with a more invasive approach involving endoscopy, mucosal biopsy, and oesophageal pH monitoring for rapidly differentiating gastro-oesophageal reflux (GOR) and cows' milk intolerance in 25 infants with persistent vomiting. Each subject underwent a cellobiose/mannitol permeability study, upper gastrointestinal endoscopy with oesophageal and small bowel biopsies, and a 24 hour pH study. Reflux disease and/or cows' milk intolerance was responsible for vomiting in 24 (96%) of the subjects. Sixteen (64%) of the infants had GOR alone, four (16%) had GOR and cows' milk intolerance, and four (16%) had cows' milk intolerance alone. Morphometric analysis of small bowel biopsies was abnormal in 19% of the patients with GOR alone and in 67% with cows' milk intolerance with or without GOR. The permeability test was abnormal in only 6% of the patients with GOR but in 100% with GOR and cows' milk intolerance and in 100% with cows' milk intolerance alone. The non-invasive permeability study aimed at rapid determination of cows' milk intolerance should pre-empt a more invasive approach in the evaluation of infants with persistent vomiting.
authors.affiliation: Department of Paediatrics, University Federico II, Naples, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Staiano
authors.forename: R
authors.initials: R
authors.lastname: Troncone
authors.forename: D
authors.initials: D
authors.lastname: Simeone
authors.forename: M
authors.initials: M
authors.lastname: Mayer
authors.forename: E
authors.initials: E
authors.lastname: Finelli
authors.forename: A
authors.initials: A
authors.lastname: Cella
authors.forename: S
authors.initials: S
authors.lastname: Auricchio
mesh_terms: D002475:Cellobiose / Q000493:pharmacokinetics; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007413:Intestinal Mucosa / Q000378:metabolism; D008297:Male; D008353:Mannitol / Q000493:pharmacokinetics; D016269:Milk Hypersensitivity / Q000175:diagnosis*; D010539:Permeability; D012680:Sensitivity and Specificity
chemical_list: D002475:Cellobiose; D008353:Mannitol