DIFFERENTIATION OF COWS MILK INTOLERANCE AND GASTROESOPHAGEAL REFLUX

The aim of this study was to compare a non-invasive test of small bowe l permeability with a more invasive approach involving endoscopy, muco sal biopsy, and oesophageal pH monitoring for rapidly differentiating gastro-oesophageal reflux (GOR) and cows' milk intolerance in 25 infan ts with persistent vomiting. Each subject underwent a cellobiose/manni tol permeability study, upper gastrointestinal endoscopy with oesophag eal and small bowel biopsies, and a 24 hour pH study. Reflux disease a nd/or cows' milk intolerance was responsible for vomiting in 24 (96%) of the subjects. Sixteen (64%) of the infants had GOR alone, four (16% ) had GOR and cows' milk intolerance, and four (16%) had cows' milk in tolerance alone. Morphometric analysis of small bowel biopsies was abn ormal in 19% of the patients with GOR alone and in 67% with cows' milk intolerance with or without GOR. The permeability test was abnormal i n only 6% of the patients with GOR but in 100% with GOR and cows' milk intolerance and in 100% with cows) milk intolerance alone. The non-in vasive permeability study aimed at rapid determination of cows' milk i ntolerance should pre-empt a more invasive approach in the evaluation of infants with persistent vomiting.