24-h intraesophageal pH determination in children allergic to cow's milk protein at a tertiary care hospital (original) (raw)
Related papers
Archives of Disease in Childhood, 1996
Aims-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 (CMSPA). Patients and 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.
Advances in Medical Sciences, 2000
The ability to differentiate between primary and secondary causes of gastroesophageal reflux (GER) is extremely important during the diagnostic procedure. At the same time, the quality of symptoms and the intensity of the course of gastroesophageal reflux disease (GERD) should be estimated. Acid GER is assessed using 24-hour esophageal pH monitoring; the results of this diagnostic test should always be interpreted alongside the clinical picture. Purpose: To establish the interdependence between the intensity of the clinical symptoms and the acid reflux index in children with primary GER and GER secondary to cow's milk protein allergy (CMA) and/or other food allergies (FA). Materials and Methods: A total of 138 children of various ages with symptoms of GERD were included in the study. The diagnostic procedure included 24-hour pH monitoring of the esophagus with a 2-channel probe (distal and proximal lead). For this purpose, ESPGAN diagnostic criteria were implemented. The type and intensity of typical manifestations of GERD were assessed with the help of our own scoring system. This diagnostic and therapeutic algorithm which includes an oral food challenge test, was applied to 138 children in order to differentiate primary GER from GER secondary to CMA/FA. Results: Primary GERD was diagnosed in 76 patients (55.1%) with a mean age: x=25.20 months ± 27.28 (group1) and GERD secondary to CMA/FA was confirmed in 62 children (44.9%) with a mean age: x = 21.53 months ± 17.79 (group 2). The most important pH-metric parameter analyzed in study groups 1 and 2 was the GER index: total and supine. An assessment of the intensity of symptoms and a comparative analysis of intensity was evaluated against the GER index: total and supine. Among study group 1, the following gradation of symptoms was found: in 31 children (40.8%) -degree 3, in 33 children (43.4%)degree 4, and in 12 children (15.8%) -degree 5, whereas among the patients in group 2:25 (40.3%) were in degree 3, 27 (43.6%) were in degree 4, and 10 (16.1%) were in degree 5. It was estimated that the higher the GER result in both total and supine positions (for both leads), the higher the level of symptoms noted. This interdependence was demonstrated for both groups. Conclusions: In seeking to determine any etiopathogenetic connection between primary GER or GER secondary to CMA/FA and their clinical consequences, 24-hour esophageal pH monitoring with a 2-channel probe is recommended, since it provides for better clinical control of GERD and its appropriate treatment.
Gastroesophageal reflux and cow's milk allergy in infants: A prospective study
Journal of Allergy and Clinical Immunology, 1996
Background: Recent reports have suggested that gastroesophageal reflux in pediatric patients may be caused by food allergy. Objective: The aim of our study was to determine the frequency of the association of gastroesophageal reflux with cow's milk protein allergy in patients in the first year of life. Methods: We studied 204 consecutive patients (median age, 6.3 months) who had been diagnosed as having gastroesophageal reflux on the basis of 24-hour continuous pH monitoring and histologic examination of the esophageal mucosa. Results: Clinical history suggested diagnosis of cow's milk allergy in 19 infants, and 93 others had positive test results (serum IgE anti-lactoglobulin, prick tests, circulating or fecal or nasal mucus' eosinophils) but did not have symptoms indicating cow's milk allergy. The cow's milk-free diet and two successive blind challenges confirmed the diagnosis of cow's milk allergy in 85 of the 204 patients with gastroesophageal reflux. The clinical presentations of the infants with gastroesophageal reflux alone were different, in view of the greater frequency of diarrhea (p < 0.0001) and atopic dermatitis (p < 0.0002). In all, gastroesophageal reflux was associated with, and probably caused by cow's milk allergy, in 85 of 204 cases (41.8%). Conclusions: Considering the frequency of this association, patients younger than 12 months old with symptoms of gastroesophageal reflux should be carefully examined to determine whether this disorder is primary or caused by cow's milk allergy. (J ALLERGY CL1N IMMUNOL 1996;97:822-7.)
Cow’s Milk Allergy or Gastroesophageal Reflux Disease—Can We Solve the Dilemma in Infants?
Nutrients
Cow’s milk allergy (CMA) and gastro-esophageal reflux disease (GERD) may manifest with similar symptoms in infants making the diagnosis challenging. While immediate reaction to cow’s milk protein indicate CMA, regurgitation, vomiting, crying, fussiness, poor appetite, sleep disturbances have been reported in both CMA and GERD and in other conditions such as functional gastrointestinal disorders, eosinophilic esophagitis, anatomic abnormalities, metabolic and neurological diseases. Gastrointestinal manifestations of CMA are often non-IgE mediated and clinical response to cow’s milk free diet is not a proof of immune system involvement. Neither for non-IgE CMA nor for GERD there is a specific symptom or diagnostic test. Oral food challenge, esophageal pH impedance and endoscopy are recommended investigations for a correct clinical classification but they are not always feasible in all infants. As a consequence of the diagnostic difficulty, both over- and under- diagnosis of CMA or GER...
Archives of Disease in Childhood, 2001
Background-Monitoring oesophageal pH conventionally detects "acid reflux" (pH less than 4). The pH of the gastric contents determines whether or not reflux can be detected. Aim-To monitor gastric and oesophageal pH simultaneously in order to determine the eVect of milk feeds on gastric pH and how this would influence interpretation of the oesophageal pH record. Methods-Milk fed infants for whom oesophageal pH monitoring was requested underwent simultaneous gastric and oesophageal pH monitoring using a dual channel pH probe. Results-Twenty of 24 records were technically satisfactory. Mean reflux index was 1.0%, range 0.0-4.0%. Gastric pH was less than 4 for 24.5% (range 0.6-69.1%) of the total time. The average time the gastric pH was greater than 4 after feeds was 130 minutes (range 29-212 minutes). The corrected reflux index (limited to the time the gastric pH was less than 4) was 2.6% (range 0.0-11.0%). Conclusion-The pH of the gastric contents may be greater than 4 for prolonged intervals, during which oesophageal pH monitoring using current criteria cannot detect reflux nor correlate it with clinical events. A low reflux index may reflect prolonged buVering of gastric acidity rather than the absence of reflux.
Food allergy in children with refractory gastroesophageal reflux disease
Pediatrics International, 2015
Background: Gastroesophageal reflux disease (GERD) and food allergy are frequent disorders of childhood. The purpose of this study was to determine the frequency of food allergy in children with refractory GERD. Methods: A total of 151 children resistant to pharmacologic GERD treatment underwent skin prick test, specific immunoglobulin E, eosinophil count, atopy patch test (APT), and oral food challenge, and were then divided into three groups according to the results of oral milk challenge and allergy work-up: group A1, positive oral milk challenge and positive IgE-mediated allergy test; group A2, positive milk challenge and negative IgE-mediated allergy test; and group B, negative oral milk challenge and negative allergy tests. Results: There were 35, 30 and 86 patients in group A1, group A2 and group B, respectively. A total of 28 of 35 patients in group A1 had cow's milk allergy and the other seven patients had egg allergy. APT positivity was more common in group A2. Endoscopic esophagitis was observed in six group A1 patients and in four group A2 patients. Bloody stools, atopic dermatitis and recurrent wheezing episodes were significantly more common in group A1 than in group A2 and group B (P < 0.001, for both). Conclusion: Cow's milk allergy was observed frequently in children resistant to pharmacologic GERD treatment. Combined skin prick and specific IgE tests, APT and oral food challenge is essential for avoidance of unnecessary elimination diet. Key words children, food allergy, gastroesophageal reflux disease. Approximately 7-8% of children are affected by food allergies, the most common being cow's milk allergy, and egg and peanut allergies. 1,2 The mechanisms involved include both immunoglobulin E (IgE)-and non-IgE-mediated reactions. 3,4 IgE-mediated allergic reactions can occur within seconds to minutes; allergies that take days to weeks to appear are more often non-IgE-mediated. Gastrointestinal (GI) manifestations of cow's milk allergy can occur in all parts of the GI tract such as the esophagus, stomach, small intestine, and/or colon and rectum. 5 Many authors emphasize the more frequent coexistence of pathological gastroesophageal reflux disease (GERD) with food allergy in children younger than 3 years old. 6-10 In infancy, this frequency can reach 40%. 6 There is a pathogenetic cause-effect relationship between these conditions. The main allergen responsible for the observed symptoms is cow's milk protein. 11 The clinical symptoms of GERD in small children are regurgitation, vomiting, failure to thrive, disturbances in growth, recurrent infections of the upper and lower respiratory tract, anxiety, irritability, disturbed sleep. These symptoms and findings are similar to those of food allergy. Therefore it is difficult to distinguish between primary gastroesophageal reflux and reflux secondary to food allergy when taking into account only the clinical picture. Chronic rhinitis, atopic dermatitis, and diarrhea are more frequently observed in children with coexisting food allergy and gastroesophageal reflux. 7-9 The diagnosis of gastroesophageal reflux secondary to food allergy is particularly important with regard to the choice of treatment method. The basic method in the treatment of gastroesophageal reflux secondary to food allergy is the introduction of elimination diets: formulas based on casein hydrolysates and whey proteins, hypoallergic diets, and anti-allergic drugs. 12 The aim of the present study was to estimate the frequency of food allergy in children <5 years of age with inadequate response to pharmacologic treatment of GERD. Methods A total of 151 children aged between 3 and 60 months with persistent vomiting and refractory GERD were included in the study. All patients underwent complete medical history that included demographic data, history of environmental, food, and drug allergies, clinical symptoms suggestive of GERD, diagnostic testing for GERD, length of symptoms, type and duration of GERD treatment, adherence to treatment, and associated comorbid states. In 96 patients, medical history indicated prescription of milkelimination diet by practitioners or pediatricians without performing allergy work-up tests. Upper endoscopy was performed in all patients; additionally, scintigraphic evaluation of gastroesophageal system or ambulatory
Current Therapeutic Research, 2003
Background: Thickened milk formulas are used to treat infants with gastroesophageal reflux (GER), but these substances often increase the duration of reflux episodes and worsen symptoms, and they have been associated with diarrhea, constipation, and cough. Objectives: The aims of this study were to determine the efficacy of an antiregurgitation milk formula in the clinical and laboratory setting in infants with proved GER, to investigate any possible adverse events (cough and change in the number of bowel movements or the consistency of stools), and to identify its effects on height and body weight. Methods: Infants with recurrent vomiting and GER who were not responsive to standard treatment were eligible for the study. Infants in the treatment group (group A) were managed for 4 weeks with a specific antiregurgitation milk formula (with cornstarch and an increased amount of casein), and those in the control group (group B) were given a standard milk formula. The number of episodes of vomiting, regurgitation, and cough, as well as the frequency and consistency of stool, height, and body weight were noted at least 10 days before and during the study. A second pH monitoring was performed after 4 weeks in both groups. Results: Fifty-six infants (30 boys, 26 girls; mean [SD] age, 3.1 [1.2] months) were included in the study; 30.4% had mild GER; 44.6%, moderate GER; and 25.0%, severe GER. Significantly more infants in group A than in group B (50.0% vs 14.3%, respectively) with mild or moderate GER had normal findings on the second pH monitoring (P Ͻ 0.05). Changes in the reflux index and in the mean number of vomiting and regurgitation episodes were significantly different between the 2 groups (P Ͻ 0.05). No significant differences in changes in the mean number of bowel movements and cough events or in the consumption time of the 2 formulas were found between the 2 groups.