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Milk-induced reflux in infants less than one year of age
F Cavataio1, A Carroccio, G Iacono
11st Divisione Pediatria, Gastroenterologia, Ospedale dei Bambini G. Di Cristina, Palermo, Italy.
Insights
Cow's milk allergy (CMA) is frequently associated with and can induce gastroesophageal reflux (GER) in infants. Pediatricians should screen infants with GER for CMA, as symptoms and diagnostic tests often overlap.
Area of Science:
- Pediatric gastroenterology
- Infant health
- Allergy and immunology
Background:
- Cow's milk allergy (CMA) and gastroesophageal reflux (GER) are common infant conditions.
- The relationship between CMA and GER in infants under one year is increasingly recognized.
- GER may be both associated with and induced by CMA.
Purpose of the Study:
- To review the relationship between CMA and GER in infants.
- To highlight commonalities in symptoms and diagnostic approaches.
- To emphasize the importance of screening for CMA in infants with GER.
Main Methods:
- Literature review of studies investigating CMA and GER in infants.
- Analysis of clinical manifestations and diagnostic findings.
- Discussion of pH-monitoring patterns in GER secondary to CMA.
Main Results:
- CMA is associated with GER in nearly half of infant cases.
- GER can be induced by CMA in a significant proportion of infants.
- Symptoms of GER associated with CMA are often indistinguishable from primary GER.
- Immunologic tests aid in diagnosing suspected CMA-GER association.
- GER secondary to CMA exhibits a distinct pH-monitoring pattern.
Conclusions:
- Pediatricians should consider screening all infants under one year with GER for concomitant CMA.
- Early identification and management of CMA can improve GER outcomes in infants.
- Understanding the interplay between CMA and GER is crucial for effective infant care.
Abstract:
Cow's milk allergy (CMA) and gastroesophageal reflux are considered to be among the most common disturbances in infants less than 1 year of age. In recent years, the relationship existing between these two entities has been investigated and some important conclusions have been reached: In just under half the cases of GER in infants less than 1 year of age there is 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 with GER less than 1 year old; 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 are useful in a suspected association between GER and CMA; and subjects with GER secondary to CMA show a typical pH-monitoring tracing pattern, characterized by a progressive, slow decrease in esophageal pH between feedings. This article reviews the main features of the two diseases, stressing the aspects in common between them and comments on all the listed points.