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Type: Journal article
Title: Characterization of upper gastrointestinal motility in infants with persistent distress and non-IgE-mediated cow's milk protein allergy
Author: Omari, T.
Tobin, J.M.
McCall, L.
Savage, K.
Ferris, L.
Hammond, P.
Kritas, S.
Quinn, P.
Abu-Assi, R.
Moore, D.
Davidson, G.
Gold, M.
Heine, R.G.
Citation: Journal of Pediatric Gastroenterology and Nutrition, 2020; 70(4):489-496
Publisher: Lippincott, Williams & Wilkins
Issue Date: 2020
ISSN: 0277-2116
Statement of
Taher Omari ... Paul Hammond ... Patrick Quinn, Rammy Abu-Assi, David Moore ... Michael Gold ... et al.
Abstract: BACKGROUND: Persistent crying in infancy is common and may be associated with gastroesophageal reflux disease (GERD) and/or non-IgE-mediated cow's milk protein allergy (CMPA). We aimed to document upper gastrointestinal motility events in infants with CMPA and compare these to findings in infants with functional GERD. METHODS: Infants aged 2 to 26 weeks with persistent crying, GERD symptoms and possible CMPA were included. Symptoms were recorded by 48-hour cry-fuss chart and validated reflux questionnaire (infant GERD questionnaire [IGERDQ]). Infants underwent a blinded milk elimination-challenge sequence to diagnose CMPA. GERD parameters and mucosal integrity were assessed by 24-hour pH-impedance monitoring before and after cow's milk protein (CMP) elimination. C-octanoate breath testing for gastric emptying dynamics, dual-sugar intestinal permeability, fecal calprotectin, and serum vitamin D were also measured. RESULTS: Fifty infants (mean age 13 ± 7 weeks; 27 boys) were enrolled. On the basis of CMP elimination-challenge outcomes, 14 (28%) were categorized as non-IgE-mediated CMPA, and 17 (34%) were not allergic to milk; 12 infants with equivocal findings, and 7 with incomplete data were excluded. There were no baseline differences in GERD parameters between infants with and without CMPA. In the CMPA group, CMP elimination resulted in a significant reduction in reflux symptoms, esophageal acid exposure (reflux index), acid clearance time, and an increase in esophageal mucosal impedance. CONCLUSIONS: In infants with persistent crying, upper gastrointestinal motility parameters did not reliably differentiate between non-IgE-mediated CMPA and functional GERD. In the group with non-IgE-mediated CMPA, elimination of CMP significantly improved GERD symptoms, esophageal peristaltic function, and mucosal integrity.
Keywords: Cow's milk allergy; esophageal motility; gastroesophageal reflux disease; mucosal integrity; pH-impedance monitoring
Rights: © 2020 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition
DOI: 10.1097/MPG.0000000000002600
Appears in Collections:Aurora harvest 8
Paediatrics publications

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