Vomiting and gastric motility in infants with cow's milk allergy

Alberto M. Ravelli, Pamela Tobanelli, Sonia Volpi, Alberto G. Ugazio

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Background: Regurgitation and vomiting are common manifestations of cow's milk protein allergy (CMPA) in infants and are usually ascribed to gastroesophageal reflux (GER). Gastric anaphylaxis can induce antral dysmotility in the rat, and therefore the hypothesis for the current study was that cow's milk in sensitized infants may impair antral motility, thereby promoting GER and reflex vomiting. Methods: Seven vomiting infants with CMPA and nine with primary GER underwent a challenge with cow's milk formula. Electrogastrography (EGG) was used to measure the spectral frequency (bradygastria = 1.5-2.4 cycles per minute [cpm], normogastria = 2.5-3.9 cpm, tachygastria = 4.0-9.0 cpm) and the postprandial-to-fasting power ratio of gastric electrical activity, whereas gastric half-emptying time (T1/2) was measured by electrical impedance tomography (EIT). Results: In CMPA and GER, respectively, during fasting, the frequency distribution (mean ± SD) of the EGG was as follows: normogastria 47.9% ± 12.5% versus 52.2% ± 9.8%, bradygastria 24.1% ± 5.7% versus 22.8% ± 8.3%, and tachygastria 28.0% ± 8.5% versus 25.0% ± 8.3%. In contrast, after the cow's milk challenge, the difference between the two groups was statistically significant: normogastria 33.1% ± 8.8% versus 70.6% ± 8.6% (P <0.0001), bradygastria 38.0% ± 15.5% versus 15.7% ± 5.2% (P = 0.002), and tachygastria 28.9% ± 10.6% versus 13.4% ± 4.6% (P = 0.001. The postprandial/fasting power ratio (mean ± SD) was 3.2 ± 1.9 in CMPA and 8.1 ± 2.1 in GER (P <0.0001). Gastric T1/2 (mean ± SD) of the cow's milk meal was 89.0 ± 26.3 minutes versus 54.0 ± 12.6 minutes (P = 0.003). In infants with GER all EGG parameters and gastric T1/2 were similar to that in 10 healthy control infants. Conclusions: In sensitized infants, cow's milk induces severe gastric dysrhythmia and delayed gastric emptying, which in turn may exacerbate GER and induce reflex vomiting. Electrogastrography and EIT can be useful in the assessment of vomiting, GER, and CMPA in infants.

Original languageEnglish
Pages (from-to)59-64
Number of pages6
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume32
Issue number1
DOIs
Publication statusPublished - 2001

Fingerprint

milk allergy
Milk Hypersensitivity
gastroesophageal reflux
gastrointestinal motility
vomiting
Gastroesophageal Reflux
Vomiting
Stomach
Milk Proteins
milk
dairy protein
stomach
hypersensitivity
Milk
cows
fasting
Fasting
Gastric Emptying
tomography
impedance

Keywords

  • Cow's milk protein allergy
  • Electrical impedance tomography
  • Electrogastrography
  • Gastroesophageal reflux
  • Vomiting

ASJC Scopus subject areas

  • Gastroenterology
  • Histology
  • Medicine (miscellaneous)
  • Food Science
  • Pediatrics, Perinatology, and Child Health

Cite this

Vomiting and gastric motility in infants with cow's milk allergy. / Ravelli, Alberto M.; Tobanelli, Pamela; Volpi, Sonia; Ugazio, Alberto G.

In: Journal of Pediatric Gastroenterology and Nutrition, Vol. 32, No. 1, 2001, p. 59-64.

Research output: Contribution to journalArticle

Ravelli, Alberto M. ; Tobanelli, Pamela ; Volpi, Sonia ; Ugazio, Alberto G. / Vomiting and gastric motility in infants with cow's milk allergy. In: Journal of Pediatric Gastroenterology and Nutrition. 2001 ; Vol. 32, No. 1. pp. 59-64.
@article{e061c5d4998e4aca80ffa8c37a83d9eb,
title = "Vomiting and gastric motility in infants with cow's milk allergy",
abstract = "Background: Regurgitation and vomiting are common manifestations of cow's milk protein allergy (CMPA) in infants and are usually ascribed to gastroesophageal reflux (GER). Gastric anaphylaxis can induce antral dysmotility in the rat, and therefore the hypothesis for the current study was that cow's milk in sensitized infants may impair antral motility, thereby promoting GER and reflex vomiting. Methods: Seven vomiting infants with CMPA and nine with primary GER underwent a challenge with cow's milk formula. Electrogastrography (EGG) was used to measure the spectral frequency (bradygastria = 1.5-2.4 cycles per minute [cpm], normogastria = 2.5-3.9 cpm, tachygastria = 4.0-9.0 cpm) and the postprandial-to-fasting power ratio of gastric electrical activity, whereas gastric half-emptying time (T1/2) was measured by electrical impedance tomography (EIT). Results: In CMPA and GER, respectively, during fasting, the frequency distribution (mean ± SD) of the EGG was as follows: normogastria 47.9{\%} ± 12.5{\%} versus 52.2{\%} ± 9.8{\%}, bradygastria 24.1{\%} ± 5.7{\%} versus 22.8{\%} ± 8.3{\%}, and tachygastria 28.0{\%} ± 8.5{\%} versus 25.0{\%} ± 8.3{\%}. In contrast, after the cow's milk challenge, the difference between the two groups was statistically significant: normogastria 33.1{\%} ± 8.8{\%} versus 70.6{\%} ± 8.6{\%} (P <0.0001), bradygastria 38.0{\%} ± 15.5{\%} versus 15.7{\%} ± 5.2{\%} (P = 0.002), and tachygastria 28.9{\%} ± 10.6{\%} versus 13.4{\%} ± 4.6{\%} (P = 0.001. The postprandial/fasting power ratio (mean ± SD) was 3.2 ± 1.9 in CMPA and 8.1 ± 2.1 in GER (P <0.0001). Gastric T1/2 (mean ± SD) of the cow's milk meal was 89.0 ± 26.3 minutes versus 54.0 ± 12.6 minutes (P = 0.003). In infants with GER all EGG parameters and gastric T1/2 were similar to that in 10 healthy control infants. Conclusions: In sensitized infants, cow's milk induces severe gastric dysrhythmia and delayed gastric emptying, which in turn may exacerbate GER and induce reflex vomiting. Electrogastrography and EIT can be useful in the assessment of vomiting, GER, and CMPA in infants.",
keywords = "Cow's milk protein allergy, Electrical impedance tomography, Electrogastrography, Gastroesophageal reflux, Vomiting",
author = "Ravelli, {Alberto M.} and Pamela Tobanelli and Sonia Volpi and Ugazio, {Alberto G.}",
year = "2001",
doi = "10.1097/00005176-200101000-00017",
language = "English",
volume = "32",
pages = "59--64",
journal = "Journal of Pediatric Gastroenterology and Nutrition",
issn = "0277-2116",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Vomiting and gastric motility in infants with cow's milk allergy

AU - Ravelli, Alberto M.

AU - Tobanelli, Pamela

AU - Volpi, Sonia

AU - Ugazio, Alberto G.

PY - 2001

Y1 - 2001

N2 - Background: Regurgitation and vomiting are common manifestations of cow's milk protein allergy (CMPA) in infants and are usually ascribed to gastroesophageal reflux (GER). Gastric anaphylaxis can induce antral dysmotility in the rat, and therefore the hypothesis for the current study was that cow's milk in sensitized infants may impair antral motility, thereby promoting GER and reflex vomiting. Methods: Seven vomiting infants with CMPA and nine with primary GER underwent a challenge with cow's milk formula. Electrogastrography (EGG) was used to measure the spectral frequency (bradygastria = 1.5-2.4 cycles per minute [cpm], normogastria = 2.5-3.9 cpm, tachygastria = 4.0-9.0 cpm) and the postprandial-to-fasting power ratio of gastric electrical activity, whereas gastric half-emptying time (T1/2) was measured by electrical impedance tomography (EIT). Results: In CMPA and GER, respectively, during fasting, the frequency distribution (mean ± SD) of the EGG was as follows: normogastria 47.9% ± 12.5% versus 52.2% ± 9.8%, bradygastria 24.1% ± 5.7% versus 22.8% ± 8.3%, and tachygastria 28.0% ± 8.5% versus 25.0% ± 8.3%. In contrast, after the cow's milk challenge, the difference between the two groups was statistically significant: normogastria 33.1% ± 8.8% versus 70.6% ± 8.6% (P <0.0001), bradygastria 38.0% ± 15.5% versus 15.7% ± 5.2% (P = 0.002), and tachygastria 28.9% ± 10.6% versus 13.4% ± 4.6% (P = 0.001. The postprandial/fasting power ratio (mean ± SD) was 3.2 ± 1.9 in CMPA and 8.1 ± 2.1 in GER (P <0.0001). Gastric T1/2 (mean ± SD) of the cow's milk meal was 89.0 ± 26.3 minutes versus 54.0 ± 12.6 minutes (P = 0.003). In infants with GER all EGG parameters and gastric T1/2 were similar to that in 10 healthy control infants. Conclusions: In sensitized infants, cow's milk induces severe gastric dysrhythmia and delayed gastric emptying, which in turn may exacerbate GER and induce reflex vomiting. Electrogastrography and EIT can be useful in the assessment of vomiting, GER, and CMPA in infants.

AB - Background: Regurgitation and vomiting are common manifestations of cow's milk protein allergy (CMPA) in infants and are usually ascribed to gastroesophageal reflux (GER). Gastric anaphylaxis can induce antral dysmotility in the rat, and therefore the hypothesis for the current study was that cow's milk in sensitized infants may impair antral motility, thereby promoting GER and reflex vomiting. Methods: Seven vomiting infants with CMPA and nine with primary GER underwent a challenge with cow's milk formula. Electrogastrography (EGG) was used to measure the spectral frequency (bradygastria = 1.5-2.4 cycles per minute [cpm], normogastria = 2.5-3.9 cpm, tachygastria = 4.0-9.0 cpm) and the postprandial-to-fasting power ratio of gastric electrical activity, whereas gastric half-emptying time (T1/2) was measured by electrical impedance tomography (EIT). Results: In CMPA and GER, respectively, during fasting, the frequency distribution (mean ± SD) of the EGG was as follows: normogastria 47.9% ± 12.5% versus 52.2% ± 9.8%, bradygastria 24.1% ± 5.7% versus 22.8% ± 8.3%, and tachygastria 28.0% ± 8.5% versus 25.0% ± 8.3%. In contrast, after the cow's milk challenge, the difference between the two groups was statistically significant: normogastria 33.1% ± 8.8% versus 70.6% ± 8.6% (P <0.0001), bradygastria 38.0% ± 15.5% versus 15.7% ± 5.2% (P = 0.002), and tachygastria 28.9% ± 10.6% versus 13.4% ± 4.6% (P = 0.001. The postprandial/fasting power ratio (mean ± SD) was 3.2 ± 1.9 in CMPA and 8.1 ± 2.1 in GER (P <0.0001). Gastric T1/2 (mean ± SD) of the cow's milk meal was 89.0 ± 26.3 minutes versus 54.0 ± 12.6 minutes (P = 0.003). In infants with GER all EGG parameters and gastric T1/2 were similar to that in 10 healthy control infants. Conclusions: In sensitized infants, cow's milk induces severe gastric dysrhythmia and delayed gastric emptying, which in turn may exacerbate GER and induce reflex vomiting. Electrogastrography and EIT can be useful in the assessment of vomiting, GER, and CMPA in infants.

KW - Cow's milk protein allergy

KW - Electrical impedance tomography

KW - Electrogastrography

KW - Gastroesophageal reflux

KW - Vomiting

UR - http://www.scopus.com/inward/record.url?scp=0035148460&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035148460&partnerID=8YFLogxK

U2 - 10.1097/00005176-200101000-00017

DO - 10.1097/00005176-200101000-00017

M3 - Article

C2 - 11176327

AN - SCOPUS:0035148460

VL - 32

SP - 59

EP - 64

JO - Journal of Pediatric Gastroenterology and Nutrition

JF - Journal of Pediatric Gastroenterology and Nutrition

SN - 0277-2116

IS - 1

ER -