J. Pediatr：牛奶激发试验或有助确诊过敏患儿的GERD

近日，国际期刊《儿科学杂志》（The Journal of Pediatrics）在线发表的一项研究显示，一些牛奶过敏患儿可能合并胃食管反流病(GERD)，而牛奶激发试验可能有助于诊断后者。

主要研究者、英国伦敦大奥蒙德街病童医院的Osvaldo Borrelli博士及其同事，对17例已确诊CMA且怀疑GERD的儿童进行了研究。研究者对受试儿童置入了多波段腔内阻抗-pH值监测器，连续监测48 h，从而得以比标准pH值监测更好地观察反流发作特点。

在前24 h内，受试儿童摄入以氨基酸为基础的配方奶，而在第2天中则接受牛奶激发。结果显示，在第2天中发生了更多的反流发作(105例次 vs. 65例次)和弱酸性发作(53例次 vs. 19例次)。

基于上述结果，研究者呼吁进一步探究下食管括约肌松弛在牛奶过敏诱发性GERD的发生中究竟扮演着怎样的角色。对于怀疑患有GERD和(或)牛奶过敏的婴幼儿，诊断中应当包括：先采取2~4周的无牛奶饮食，然后进行牛奶激发，以便确诊或排除牛奶过敏。

研究者总结认为，在阻抗-pH值监测期间进行牛奶激发试验，可作为客观检查项目用于确定早期和晚期症状反复发生是否的确与反流有关。（生物谷Bioon.com）

doi:10.1016/j.jpeds.2012.03.002
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Cow’s Milk Challenge Increases Weakly Acidic Reflux in Children with Cow’s Milk Allergy and Gastroesophageal Reflux Disease

Osvaldo Borrelli, MD, Valentina Mancini, MD, Nikhil Thapar, MD, Valentina Giorgio, MD, Mamoun Elawad, MD, Susan Hill, MD, Neil Shah, MD, Keith J. Lindley, MD

Objective

To assess and compare the pattern of reflux in a selected population of infants with cow’s milk (CM) allergy (CMA) and suspected gastroesophageal reflux disease (GERD) while on dietary exclusion and following challenge with CM.

Study design

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.

Results

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).

Conclusions

In children with CMA and suspected 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.