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Characterization of Upper Gastrointestinal Motility in Infants With Persistent Distress and Non-IgE-mediated Cow's
Taher Omari1, Jacinta M Tobin2, Lisa McCall3
1College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia.
Insights
Persistent crying in infants may stem from GERD or CMPA. Upper GI motility didn't distinguish between these conditions, but removing cow's milk protein improved CMPA infant symptoms and esophageal function.
Area of Science:
- Pediatric Gastroenterology
- Allergy and Immunology
Background:
- Persistent crying in infants is a common issue.
- It can be linked to gastroesophageal reflux disease (GERD) and non-IgE-mediated cow's milk protein allergy (CMPA).
Purpose of the Study:
- To investigate upper gastrointestinal motility in infants with CMPA.
- To compare these motility events with those in infants diagnosed with functional GERD.
Main Methods:
- Included infants aged 2-26 weeks with crying, GERD symptoms, and suspected CMPA.
- Utilized 48-hour cry-fuss charts, GERD questionnaires, and pH-impedance monitoring.
- Assessed gastric emptying, intestinal permeability, and fecal calprotectin.
Main Results:
- No significant baseline differences in GERD parameters were found between infants with and without CMPA.
- CMP elimination in the CMPA group led to reduced reflux symptoms and improved esophageal function.
- Esophageal acid exposure decreased, and mucosal impedance increased after CMP elimination.
Conclusions:
- Upper gastrointestinal motility parameters did not reliably differentiate non-IgE-mediated CMPA from functional GERD in infants with persistent crying.
- Cow's milk protein elimination significantly improved GERD symptoms, esophageal peristalsis, and mucosal integrity in infants with CMPA.
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.
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