Archives ofDisease in Childhood 1995; 73: 439-442 Differentiation of cows ' milk intolerance and gastro-oesophageal reflux

The aim of this study was to compare a non-invasive test of small bowel perme-ability with a more invasive approach involving endoscopy, mucosal biopsy, and oesophageal pH monitoring for rapidly differentiating gastro-oesophageal reflux (GOR) and cows ' milk intolerance in 25 infants with persistent vomiting. Each subject underwent a cellobiose/mannitol permeability study, upper gastrointestinal endoscopy with oesophageal and small bowel biopsies, and a 24 hour pH study. Reflux disease and/or cows ' milk intol-erance was responsible for vomiting in 24 (96%) ofthe subjects. Sixteen (64%) ofthe infants had GOR alone, four (16%) had GOR and cows ' milk intolerance, and four (16%) had cows ' milk intolerance alone. Morphometric analysis of small bowel biopsies was abnormal in 19 % of the patients with GOR alone and in 67 % with cows ' milk intolerance with or without GOR. The permeability test was abnor-mal in only 6 % of the patients with GOR but in 100 % with GOR and cows ' milk intolerance and in 100 % with cows' milk intolerance alone. The non-invasive permeability study aimed at rapid determination of cows' milk intolerance should pre-empt a more invasive approach in the evaluation of infants with persistent vomiting