Cows Milk Challenge Increases Weakly Acidic Reflux in Children with Cows Milk Allergy and Gastroesophageal Reflux Disease

The Journal of Pediatrics, 05/08/2012

Borrelli O et al. – In children with cow’s milk (CM) allergy (CMA) and suspected gastroesophageal reflux disease (GERD), CM exposure increases the number of weakly acidic reflux episodes. CM challenge during 48–hour multichannel intraluminal impedance–pH monitoring identifies a subgroup of patients with allergen–induced reflux, and in selected cases of children with CMA in whom GERD is suspected, its use could be considered as part of diagnostic work–up.


  • Seventeen children (median age: 14 months) with a proven diagnosis of CMA and suspected GERD underwent 48-hour multichannel intraluminal impedance-pH monitoring.
  • For the first 24 hours, the infants were kept on amino acid–based formula, and for the subsequent 24 hours, they were challenged with CM.


  • The total reflux episodes and the number of weakly acidic episodes were higher during CM challenge compared with the amino acid–based formula period [total reflux episodes: 105 (58-127.5) vs 65 (39-87.5), P < .001; weakly acidic episodes: 53 (38.5-60.5) vs 19 (13-26.5), P < .001; median (25th-75th)].
  • No differences were found for either acid or weakly alkaline episodes (not significant).
  • The number of weakly acidic episodes reaching the proximal, mid, and distal esophagus was higher during CM challenge (P < .001).
  • No differences were found in either acid exposure time or number of long-lasting episodes (not significant).

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