Vomiting and Gastric Motility in Infants With Cow's Milk Allergy

Since cow's milk protein allergy (CMPA) is the most common food-induced allergy in human infants, and since in the rat model, sensitized animals are known to develop gastric anaphalaxis, the authors hypothesized that antral dysmotility with delayed gastric emptying and vomiting could be detected with surface recordings. This study was done in Italy with 3 groups of infants: 7 with CMPA, 9 with gastroesophageal reflux (GER), and 10 healthy controls. Regurgitation and vomiting are common to both CMPA and GER. In order to look for differences between the 2 disorders, the authors used noninvasive methods of testing with surface electrodes to record gastric physiological activity and simultaneously gastric emptying by electrical impedance technology (EIT). Electrogastrography (EGG) measured the cycles per minute (cpm) of gastric myoelectrical activity. Normal gastric waves or normogastria was defined as 2.5-3.9 cpm. Bradygastria is 1.5-2.4 cpm, and tachygastria is defined as 4.0-9.0 cpm. During the fasting period gastric rhythms were similar in all groups. However, following a challenge with cow's milk formula, the EGG was significantly different in the babies with CMPA, showing statistically significant slowing. The GER patients had EGG values similar to controls. The infants with CMPA had significantly slower gastric emptying after consuming cow's milk compared to the GER and control groups. The group observed that in sensitized infants, the cow's milk protein induces severe gastric dysrhythmia and delayed gastric emptying. This was felt to exacerbate GER and induce reflex vomiting. The conclusion was that EGG and EIT can be useful in the evaluation of vomiting, GER, and CMPA in infants.