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https://hdl.handle.net/2440/128184
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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 1536-4801 |
Statement of Responsibility: | 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 |
Grant ID: | NHMRC NHMRC |
Published version: | http://dx.doi.org/10.1097/mpg.0000000000002600 |
Appears in Collections: | Aurora harvest 8 Paediatrics publications |
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