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Ovid: P1008 A PROSPECTIVE CLINICAL, PHYSIOLOGICAL, AND HISTOL

Journal of Pediatric Gastroenterolog and Nutrition Issue: Volume 39 Supplement 1, June 2004, pp S440-S441 Copyright: 2004 Lippincott Williams & Wilkins, Inc. Publication Type: [ABSTRACTS: Poster Session Abstracts] ISSN: 0277-2116 Accession: 00005176-200406001-01132 [ABSTRACTS: Poster Session Abstracts]

P1008 A PROSPECTIVE CLINICAL, PHYSIOLOGICAL, AND HISTOLOGICAL STUDY IN THE INFANTS AND CHILDREN WITH GASTRO-ESOPHAGEAL REFLUX (GER) AND COW S MILK INTOLERANCE
Ida, S.1; Kubota, M .2; Yoshimura, N.1; Etani, Y.3; M ushiake, S.3; Kawahara, H.4

Author Information
1Pediatric Gastroenterolog Hepatolog and Nutrition, Osaka Medical Center and Research Institute for Maternal and Child Health, I umi, 2Pediatrics, Hokkaido

Universit , Sapporo, 3Developmental Medicine, Pediatrics, Osaka Universit Graduate School of Medicine, Suita, 4Pediatric Surger , Osaka Medical Center and Research Institute for Maternal and Child Health, I umi, Japan Submitted by: idas@mch.pref.osaka.jp Introduction: GER is caused mainly by a transient lower esophageal sphincter (LES) relaxation through the vagal reflex. And GER is closely related to cow s milk allergy. There is little reports showing the characteristics in the children with GER and cow s milk allergy. The aim of this study is to show the clinical, physiological and histological characteristics of infants and children with GER and cow s milk intolerance.

Methods: Eleven children less than 7 years old (mean2.2y.o) who have recurrent emesis were studied prospectively.Endoscopic and histologic study were done. Imuunohistochemistry for substance P and histamine was also performed. Gastric scintigraphy for the evaluation of gastric emptying,24h-pH monitoring and UGI were studied. Blood tests (IgE, RAST, and lymphocyte stimulation test), the challenge and elimination tests for cow s milk were done.

Results: All these children responded the elimination and challenge tests for cow s milk and considered cow s milk intolerance clinically. The lymphocyte stimulation test showed positive for cow s milk(mean SI 430%,normal:180%). 24-hour lower esophageal pH monitoring slowed GER (time of pH4were 620%) Delayed gastric emptying with cow s milk was shown,on the other hand, normal emptying with hypoallergic formula (25%vs63%:the difference was significant). Gastrointestinal morphology: mild esophagitis in 9 children and severe esophagitis with gastric metaplasia and eosinopills infetretion in one child were shown.Gastric mucosa was almost normal in all patients. Duodenitis with villous atrophy and mild eosinophilic infiltration, mast cell with histamine and increase in substance P positive nerve were shown in 10 chidren. From these results, the mechanism of GER secondary to food intolerance are considered as follows:cow s milk allergy causes duodenitis with histamine and substance P which causes duodenal break (contraction of the pylorus) and delayed gastric emptying occurs,then trancient LES relaxation is induced,and finally GER occurs.

Conclusion: Duodenitis with chemical mediators such as substance P and histamine caused by cowfs milk intolerance may play an important role for the cause of GER in children.

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