title: Clinical and pH-metric characteristics of gastro-oesophageal reflux secondary to cows' milk protein allergy.
abstract: OBJECTIVE
  The primary aim was to assess whether there were differences in symptoms, laboratory data, and oesophageal pH-metry between infants with primary gastro-oesophageal reflux and those with reflux secondary to cows' milk protein allergy (CMPA).
  
  
  METHODS
  96 infants (mean(SD) age 7.8(2.0) months) with either primary gastro-oesophageal reflux, reflux with CMPA, CMPA only, or none of these (controls) were studied. Symptoms, immunochemical data, and oesophageal pH were compared between the four groups and the effect of a cows' milk protein-free diet on the severity of symptoms was also assessed.
  
  
  RESULTS
  14 out of 47(30%) infants with gastro-oesophageal reflux had CMPA. These infants had similar symptoms to those with primary gastro-oesophageal reflux but higher concentrations of total IgE and circulating eosinophils (p < 0.005) and IgG anti-beta lactoglobulin (p < 0.003). A progressive constant reduction in oesophageal pH at the end of a feed, which continued up to the next feed, was seen in 12 out of 14 patients with gastro-oesophageal reflux secondary to CMPA and in 24 of 25 infants with CMPA only. No infants with primary gastro-oesophageal reflux and none of the controls had this pattern. A cows' milk protein-free diet was associated with a significant improvement in symptoms only in infants with gastro-oesophageal reflux with CMPA.
  
  
  CONCLUSIONS
  A characteristic oesophageal pH pattern is useful in distinguishing infants with gastro-oesophageal reflux associated with CMPA.
authors.affiliation: Division of Paediatrics II, Ospedale Di Cristina, Palermo, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Cavataio
authors.forename: G
authors.initials: G
authors.lastname: Iacono
authors.forename: G
authors.initials: G
authors.lastname: Montalto
authors.forename: M
authors.initials: M
authors.lastname: Soresi
authors.forename: M
authors.initials: M
authors.lastname: Tumminello
authors.forename: A
authors.initials: A
authors.lastname: Carroccio
mesh_terms: D003937:Diagnosis, Differential; D018753:Diet, Protein-Restricted; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000178:diet therapy / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D008297:Male; D016269:Milk Hypersensitivity / Q000150:complications* / Q000178:diet therapy / Q000503:physiopathology; D008894:Milk Proteins / Q000009:adverse effects*
chemical_list: D008894:Milk Proteins