GASTROESOPHAGEAL REFLUX AND COWS MILK ALLERGY IN INFANTS - A PROSPECTIVE-STUDY

Background: Recent reports have suggested that gastroesophageal reflux in pediatric patients may be caused by food allergy. Objective: The a im of our study was to determine the frequency of the association of g astroesophageal 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 gastroesophag eal reflux on the basis of 24-hour continuous pH monitoring and histol ogic examination of the esophageal mucosa. Results: Clinical history s uggested diagnosis of cow's milk allergy in 19 infants, arm 93 others had positive test results (serum IgE anti-lactoglobulin, prick tests c irculating or fecal or nasal mucus eosinophils) but did nor have sympt oms indicating cow's milk allergy. The cow's milk-free diet and two su ccessive blind challenges confirmed the diagnosis of cow's milk allerg y 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 ass ociated with, and probably caused by COM'S milk allergy, in 85 of 204 cases (41.5%). Conclusions: Considering the frequency of this associat ion, patients younger than 12 months old old with symptoms of gastroes ophageal reflux should be carefully examined to determine whether this disorder is primary or caused by cow's milk allergy.