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/22/11 Ovid: P1008 A PROSPECTIVE CLINICAL, PHYSIOLOGICAL, AND HISTOL

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[ABSTRACTS: Poster Session Abstracts]

Journal of Pediatric Gastroenterolog and Nutrition

Issue: Volume 39 Supp lement 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

P1008 A PROSPECTIVE CLINICAL, PHYSIOLOGICAL, AND HISTOLOGICAL STUDY IN THE INFANTS AND CHILDREN WITH

GASTRO-ESOPHAGEAL REFLUX (GER) AND COWS MILK INTOLERANCE

Ida, S.1; Kubota, M.2; Yoshimura, N.1; Etani, Y.3; Mushiake, S.3; Kawahara, H.4

Author Information1Pediatric Gastroenterolog Hepatolog and Nutrition, Osaka Medical Center and Research Institute for Maternal and Child Health, Iumi,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, Iumi, 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 cows milk

allergy. There is little reports showing the characteristics in the children with GER

and cows milk allergy. The aim of this study is to show the clinical, physiological and

histological characteristics of infants and children with GER and cows 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 cows milk were done.

Results: All these children responded the elimination and challenge tests for

cows milk and considered cows milk intolerance clinically. The lymphocyte

stimulation test showed positive for c ows milk(mean SI 430%,normal:180%). 24-hour

lower esophageal pH monitoring slowed GER (time of pH4were 620%) Delayed gastric

emptying with cows milk was shown,on the other hand, normal emptying with hypo-

allergic formula (25%vs63%:the difference was s ignificant). Gastrointestinalmorphology: 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:cows 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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