CLINICAL AND PH-METRIC CHARACTERISTICS OF GASTROESOPHAGEAL REFLUX SECONDARY TO COWS MILK PROTEIN ALLERGY

Aims-The primary aim was to assess whether there were differences in s ymptoms, laboratory data, and oesophageal pH-metry between infants wit h primary gastro-oesophageal reflux and those with reflux secondary to cows) milk protein allergy (CMPA). Patients and methods-96 infants (m ean(SD) age 7.8(2.0) months) with either primary gastro-oesophageal re flux, reflux with CMPA, CMPA only, or none of these (controls) were st udied. Symptoms, immunochemical data, and oesophageal pH were compared between the four groups and the effect of a cows' milk protein-free d iet on the severity of symptoms was also assessed. Results-14 out of 4 7(30%) infants with gastro-oesophageal reflux had CMPA. These infants had similar symptoms to those with primary gastro-oesophageal reflux b ut higher concentrations of total IgE and circulating eosinophils (p < 0.005) and IgG anti-beta lactoglobulin (p < 0.003). A progressive con stant reduction in oesophageal pH at the end of a feed, which continue d up to the next feed, was seen in 12 out of 14 patients with gastro-o esophageal reflux secondary to CMPA and in 24 of 25 infants with CMPA only. No infants with primary gastrooesophageal reflux and none of the controls had this pattern. A cows' milk protein-free diet was associa ted with a significant improvement in symptoms only in infants with ga stro-oesophageal reflux with CMPA. Conclusion-A characteristic oesopha geal pH pattern is useful in distinguishing infants with gastro-oesoph ageal reflux associated with CMPA.