Clinical and pH-metric characteristics of gastro-oesophageal reflux secondary to cows' milk protein allergy.
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.
Cavataio
F
F
Division of Paediatrics II, Ospedale Di Cristina, Palermo, Italy.
Iacono
G
G
Montalto
G
G
Soresi
M
M
Tumminello
M
M
Carroccio
A
A
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*
D008894:Milk Proteins