Gastroesophageal reflux (GER) in children and adolescents with regard to food intolerance.

PURPOSE: The hypothesis put forward in the current study was that food intolerance can be a cause of gastroesophageal reflux (GER) affecting children with this pathology at various age. In order to confirm or exclude this hypothesis, the study objective was to determine the frequency of the cause-and-effect relationship between allergy to cow milk proteins and/or other food products and gastroesophageal reflux found in the study group of patients, and to establish diagnostic differentiation guidelines in GER caused by food intolerance, i.e. secondary vs primary GER.

MATERIAL AND METHODS: A total of 735 children (428 boys--58.2% and 307 girls--41.8%; mean age x = 41.12 months +/- 25.03) with symptoms suggesting gastroesophageal reflux disease (GERD) were qualified for the study. The diagnostic procedure included a 24 h pH-metry of the oesophagus, which was performed in all the study children. In 703 patients (411 boys--55.9% and 292 girls--39.7%) upper gastrointestinal endoscopy was carried out. Manometric examination of the oesophagus was performed in 232 children (123 boys--16.7% and 109 girls--14.8%). Allergological and immunological tests were done in 170 children with suspected allergy (91 boys--12.4% and 79 girls--10.7%). Contrast radiography of the upper gastrointestinal tract was performed in 78 children with respiratory symptoms (42 boys--5.7% and 36 girls--4.9%). Oral challenge test was used to differentiate primary GER from GER secondary to cow milk proteins intolerance or other food allergy in 138 children (72 boys--9.8% and 66 girls--8.9%).

RESULTS: Based on the 24 h pH-metry of the oesophagus and endoscopic examination of the upper gastrointestinal tract, gastroesophageal reflux disease and/or reflux oesophagitis were diagnosed in 138 study subjects (18.8%); mean age x = 23.36 months +/- 22.53. Positive oral food challenge test confirmed pathological GER secondary to cow milk protein allergy/other food hypersensitivity in 62 children (8.4%).

CONCLUSION: The current study revealed the existence of the cause-and-effect relationship between allergy to cow milk protein/ /other food products and GER in the study children at various age.