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Gastro-oesophageal Reflux and Cow’s Milk Allergy

  • Francesco Valitutti
  • Anna Rybak
  • Osvaldo Borrelli
Chapter

Abstract

Gastro-esophageal reflux disease (GERD) and cow’s milk allergy protein (CMPA) and are both common disorders in childhood, mainly infancy, and several studies have hypothesised a causal relationship between them, suggesting that at least in a subgroup of infants GERD is attributable to CMA. In children with CMPA, a neuroimmune interactions provoked by cow’s milk challenge might induce gastric motor abnormalities and in turn increase the number of reflux episodes. Studies assessing the relationship between the two conditions have shown an association ranging between 16 and 55%, which is far beyond from that expected from pure coexistence. Therefore, a possible concomitant CMPA, mainly in those infants and children with GERD unresponsive to medical treatment data, should be highly considered. Current ESPGHAN-NASPGHAN guidelines already suggest a short trial cow’s milk free diet in those infants with chronic regurgitation unresponsive to medical therapy, vomiting and failure to thrive.

Keywords

Gastroesophageal reflux Cow’s milk protein allergy pHmetry pH-impedance 

References

  1. 1.
    Rajan TV. The Gell-Coombs classification of hypersensitivity reactions: a re-interpretation. Trends Immunol. 2003;24:376–9.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Savage J, et al. Food allergy: epidemiology and natural history. Immunol Allergy Clin N Am. 2015;35:45–59.CrossRefGoogle Scholar
  3. 3.
    Kattan I. The prevalence and natural history of food allergy. Curr Allergy Asthma Rep. 2016;16:47.CrossRefPubMedGoogle Scholar
  4. 4.
    Hill DA, et al. The epidemiologic characteristics of healthcare provider-diagnosed eczema, asthma, allergic rhinitis, and food allergy in children: a retrospective cohort study. BMC Pediatr. 2016;16:133.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Burks AW, et al. ICON: food allergy. J Allergy Clin Immunol. 2012;129:906–20.CrossRefPubMedGoogle Scholar
  6. 6.
    Bjorksten B, et al. Criteria for identifying allergenic foods of public health importance. Regul Toxicol Pharmacol. 2008;51:42–52.CrossRefPubMedGoogle Scholar
  7. 7.
    Warren CM, et al. The epidemiology of milk allergy in US children. Ann Allergy Asthma Immunol. 2013;110:370–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Sackesen C, et al. Cow's milk allergy as a global challenge. Curr Opin Allergy Clin Immunol. 2011;11:243–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Gupta R, et al. The economic impact of childhood food allergy in the United States. JAMA Pediatr. 2013;167:1026–31.CrossRefPubMedGoogle Scholar
  10. 10.
    Forget P, et al. Cow’s milk protein allergy and gastro-oesophageal reflux. Eur J Pediatr. 1985;144:298–300.CrossRefPubMedGoogle Scholar
  11. 11.
    Bischoff S, Crowe SE. Gastrointestinal food allergy: new insights into pathophysiology and clinical perspectives. Gastroenterology. 2005;128:1089–113.CrossRefPubMedGoogle Scholar
  12. 12.
    Collins SM. The immunomodulation of enteric neuromuscular function: implications for motility and inflammatory disorders. Gastroenterology. 1996;111:1683–99.CrossRefPubMedGoogle Scholar
  13. 13.
    Barbara G, Stanghellini V, De Giorgio R, et al. Functional gastrointestinal disorders and mast cells: implications for therapy. Neurogastroenterol Motil. 2006;8:6–17.CrossRefGoogle Scholar
  14. 14.
    Catto-Smith AG, Patrick MK, Scott RB, et al. Gastric response to mucosal IgE-mediated reactions. Am J Phys. 1989;257:G704–8.Google Scholar
  15. 15.
    Diamant S, Gall D, Scott R. The effect of intestinal anaphylaxis on postprandial motility in the rat. Can J Physiol Pharmacol. 1989;67:1326–30.CrossRefPubMedGoogle Scholar
  16. 16.
    Scott RB, Diamant SC, Gall DG. Motility effects of intestinal anaphylaxis in the rat. Am J Phys. 1998;255:G505–11.Google Scholar
  17. 17.
    Saavedra Y, Vergara P. Hypersensitivity to ovalbumin induces chronic intestinal dysmotility and increases the number of intestinal mast cells. Neurogastroenterol Motil. 2005;17:112–22.CrossRefPubMedGoogle Scholar
  18. 18.
    Ravelli AM, Tobanelli P, Volpi S, Ugazio AG. Vomiting and gastric motility in infants with cow’s milk allergy. J Pediatr Gastroenterol Nutr. 2001;32:59–64.CrossRefPubMedGoogle Scholar
  19. 19.
    Schäppi MG, et al. Mast cell-nerve interactions in children with functional dyspepsia. J Pediatr Gastroenterol Nutr. 2008;47:472–80.CrossRefPubMedGoogle Scholar
  20. 20.
    Cocks TM, et al. Protease-activated receptors mediate apamin-sensitive relaxation of mouse and guinea pig gastrointestinal smooth muscle. Gastroenterology. 1999;116:586–92.CrossRefPubMedGoogle Scholar
  21. 21.
    Nishikawa H, et al. Suppression by protease activated receptor-2 activation of gastric acid secretion in rats. Eur J Pharmacol. 2002;447:87–90.CrossRefPubMedGoogle Scholar
  22. 22.
    Chen JZ, et al. Abnormal gastric myoelectrical activity and delayed gastric emptying in patients with symptoms suggestive of gastroparesis. Dig Dis Sci. 1996;8:1538–45.CrossRefGoogle Scholar
  23. 23.
    Emerenziani S, et al. Gastroesophageal reflux and gastric emptying, revisited. Curr Gastroenterol Rep. 2005;7:190–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Hegar B, et al. Natural evolution of regurgitation in healthy infants. Acta Paediatr. 2009;98:1189–93.CrossRefPubMedGoogle Scholar
  25. 25.
    Vandenplas Y, et al. Guidelines for the diagnosis and management of cows’ milk protein allergy in infants. Arch Dis Child. 2007;92:902–8.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Salvatore S, et al. Gastroesophageal reflux and cow’s milk allergy: is there a link? Pediatrics. 2002;110:972–98.CrossRefPubMedGoogle Scholar
  27. 27.
    Iacono G, et al. Gastroesophageal reflux and cow’s milk allergy in infants: a prospective study. J Allergy Clin Immunol. 1996;97:822–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Yukselen A, et al. Food allergy in children with refractory gastroesophageal reflux disease. Pediatr Int. 2016;58:254–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Cavataio F, et al. Clinical and pH-metric characteristics of gastro-oesophageal reflux secondary to cows’ milk protein allergy. Arch Dis Child. 1996;75:51–6.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Cavataio F, et al. Gastroesophageal reflux associated with cow’s milk allergy in infants: which diagnostic examinations are useful? Am J Gastroenterol. 1996;91:1215–20.PubMedGoogle Scholar
  31. 31.
    Milocco C, et al. Gastro-oesophageal reflux and cows’ milk protein allergy. Arch Dis Child. 1997;77:183–8.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Nielsen RG, et al. Severe gastroesophageal reflux disease and cow milk hypersensitivity in infants and children: disease association and evaluation of a new challenge procedure. J Pediatr Gastroenterol Nutr. 2004;39:383–91.CrossRefPubMedGoogle Scholar
  33. 33.
    Kamer B, et al. Gastroesophageal reflux in infants with food allergy. Med Sci Monit. 2000;6:348–52.PubMedGoogle Scholar
  34. 34.
    Borrelli O, et al. Cow’s milk challenge increases weakly acidic reflux in children with cow’s milk allergy and gastroesophageal reflux disease. J Pediatr. 2012;161:476–81.CrossRefPubMedGoogle Scholar
  35. 35.
    Semeniuk J, et al. Manometric study of lower esophageal sphincter in children with primary acid gastroesophageal reflux and acid gastroesophageal reflux secondary to food allergy. Adv Med Sci. 2008;53:283–92.PubMedGoogle Scholar
  36. 36.
    Vandenplas Y, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009;49:498–547.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Francesco Valitutti
    • 1
  • Anna Rybak
    • 1
  • Osvaldo Borrelli
    • 1
  1. 1.Department of Paediatric Gastroenterology, Division of Neurogastroenterology and MotilityICH University College of London, Great Ormond Street Hospital for ChildrenLondonUK

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