title: Role of food protein intolerance in infants with persistent distress attributed to reflux esophagitis.
abstract: BACKGROUND
  Distressed behavior is common in infants and is often attributed to gastroesophageal reflux (GER) or food protein intolerance.
  
  
  OBJECTIVE
  To examine the effect of a hypoallergenic amino acid-based infant formula (AAF) on distressed behavior and GER symptoms in infants who failed to respond to extensively hydrolyzed formula and antireflux medications.
  
  
  METHODS
  Nineteen distressed infants (9 boys and 10 girls; median age, 5.0 months) with presumed GER underwent gastroscopy (n = 17) and esophageal 24-hour pH monitoring (n = 14). Double-blind placebo-controlled (DBPC) formula challenges of AAF versus previously besttolerated formula were conducted.
  
  
  RESULTS
  Nine infants had histologic evidence of esophagitis, and 9 had inflammatory changes in the stomach and/or duodenum. Symptoms remitted in all infants within 2 weeks of the start of feeding with AAF. On DBPC challenge after a median period of 3 months of receiving AAF, 12 infants were intolerant to active formula (distress score, 287 vs 580 min/wk,P =. 01; symptom score, 23.1 vs 36.1, P =.03). Seven infants did not relapse and were considered tolerant (distress score, 470 vs 581, P =.77; symptom score, 29.5 vs 20.2; P =.89).
  
  
  CONCLUSIONS
  Treatment with AAF may reduce distressed behavior and symptoms of GER in infants with food protein intolerance.
authors.affiliation: Departments of Allergy, Gastroenterology & Clinical Nutrition, and Anatomical Pathology, Royal Children's Hospital, Melbourne, Australia.
authors.forename: D J
authors.initials: DJ
authors.lastname: Hill
authors.forename: R G
authors.initials: RG
authors.lastname: Heine
authors.forename: D J
authors.initials: DJ
authors.lastname: Cameron
authors.forename: A G
authors.initials: AG
authors.lastname: Catto-Smith
authors.forename: C W
authors.initials: CW
authors.lastname: Chow
authors.forename: D E
authors.initials: DE
authors.lastname: Francis
authors.forename: C S
authors.initials: CS
authors.lastname: Hosking
mesh_terms: D000596:Amino Acids / Q000627:therapeutic use; D004044:Dietary Proteins / Q000009:adverse effects*; D004311:Double-Blind Method; D004942:Esophagitis, Peptic / Q000150:complications*; D005260:Female; D005512:Food Hypersensitivity / Q000150:complications*; D006801:Humans; D007223:Infant; D018730:Infant Behavior; D007225:Infant Food; D008297:Male; D016269:Milk Hypersensitivity / Q000150:complications; D014839:Vomiting / Q000209:etiology
chemical_list: D000596:Amino Acids; D004044:Dietary Proteins