Posted by: Indonesian Children | May 9, 2010

Gastroesophageal Reflux and Cow Milk Allergy: Is There a Link?

PEDIATRICS Vol. 110 No. 5 November 2002, pp. 972-984
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Gastroesophageal Reflux and Cow Milk Allergy: Is There a Link?

Silvia Salvatore, MD*, Yvan Vandenplas, MD, PhD{ddagger}  

* Pediatrics, Clinica Pediatrica di Varese, Università dell’Insubria, Brussels, Belgium
{ddagger} Pediatrics, Academisch Ziekenhuis, Vrije Universiteit Brussel, Brussels, Belgium

Gastroesophageal reflux (GER) and cow milk allergy (CMA) occur frequently in infants younger than 1 year. In recent years, the relation between these 2 entities has been investigated and some important conclusions have been reached: in up to half of the cases of GER in infants younger than 1 year, there may be an association with CMA. In a high proportion of cases, GER is not only CMA associated but also CMA induced. The frequency of this association should induce pediatricians to screen for possible concomitant CMA in all infants who have GER and are younger than 1 year. With the exception of some patients with mild typical CMA manifestations (diarrhea, dermatitis, or rhinitis), the symptoms of GER associated with CMA are the same as those observed in primary GER. Immunologic tests and esophageal pH monitoring (with a typical pH pattern characterized by a progressive, slow decrease in esophageal pH between feedings) may be helpful if an association between GER and CMA is suspected, although the clinical response to an elimination diet and challenge is the only clue to the diagnosis. This article reviews the main features of GER and CMA, focusing on the aspects in common and the discrepancies between both conditions.  

Key Words: cow milk allergy • gastroesophageal reflux • vomiting • (esophageal) pH monitoring

Abbreviations: GER, gastroesophageal reflux • GERD, gastroesophageal reflux disease • CMA, cow milk allergy • CMI, cow milk intolerance • CM, cow milk • Ig, immunoglobulin • CMP, cow milk protein • CMFD, cow milk-free diet • AAF, amino acid-based formula • eHF, extensive hydrolysate formula • LES, lower esophageal sphincter • HPF, high-power field • PPI, proton pump inhibitor • IL, interleukin

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