Ricerca
IGARIS
(Iatrogenic Ghost Allergy and Reflux Infant Sindrome): una nuova forma iatrogenica di rifiuto del cibo
IGARIS (Iatrogenic Ghost Allergy and Reflux Infant Sindrome): a new iatrogenic form of food refusal
Andrea Taddio1,2, Zemira Cannioto3, Egidio Barbi1, Federico Marchetti1,3, Massimo Maschio1, Stefano Martelossi1, Lorenzo Monasta1, Matteo Bramuzzo, Alessandro Ventura1,2
1IRCCS Materno-Infantile “Burlo Garofalo”, Trieste
2Università di Trieste
3UOC di Pediatria, Ospedale di Ravenna, AUSL della Romagna
Novembre 2017 - pagg. 571 -576
Abstract
Background - ood refusal (FR) may be related to organic conditions such as gastroesophageal
reflux disease (GERD) and food allergy (FA). Recent findings have shown
a GERD and FA overdiagnosis. Inaccurate GERD or FA diagnosis may lead to iatrogenic
FR.
Aims - To evaluate if an improper diagnosis of GERD and/or Food Allergy may cause FR in infants and children.
Materials and methods - All children with a diagnosis of FR diagnosed at the paediatric unit of the IRCCS “Burlo-Garofolo” in Trieste (Italy) between January 2009 and December 2013 were enrolled. According to the final diagnosis all patients were divided into two groups: organic and non-organic FR. Among the non-organic FR patients a third group of patients with a previous improper diagnosis of GERD and/or FA was identified and described. Children and adolescents with a final diagnosis of anorexia nervosa have been excluded. Clinical data were evaluated with multivariate analysis. Patients classified as non-organic FR were then contacted by a follow-up phone survey.
Results - The study population consisted of 186 patients. Eighty-three (45%) presented with an underlying organic condition and 103 (65%) presented with a non-organic FR; among this group, 36 patients (19.3%) presented a functional FR while in 67 (36.1%) FR appeared related to an inappropriate GERD and/or FA diagnosis and was then defined as iatrogenic. Among this subgroup of patients, FA and GERD were subsequently excluded, all therapy stopped and free diet reintroduced without any clinical problem. At discharge all children tolerated a normal diet without no therapy. At follow-up phone survey among iatrogenic subgroup patients, 93% of parents did not report any symptom evocative of GERD or FA.
Conclusion - An improper FA or GERD diagnosis may cause severe food refusal with failure to thrive. This condition has been defined as “Iatrogenic Ghost Allergy and Reflux Infant Syndrome” (IGARIS).
Aims - To evaluate if an improper diagnosis of GERD and/or Food Allergy may cause FR in infants and children.
Materials and methods - All children with a diagnosis of FR diagnosed at the paediatric unit of the IRCCS “Burlo-Garofolo” in Trieste (Italy) between January 2009 and December 2013 were enrolled. According to the final diagnosis all patients were divided into two groups: organic and non-organic FR. Among the non-organic FR patients a third group of patients with a previous improper diagnosis of GERD and/or FA was identified and described. Children and adolescents with a final diagnosis of anorexia nervosa have been excluded. Clinical data were evaluated with multivariate analysis. Patients classified as non-organic FR were then contacted by a follow-up phone survey.
Results - The study population consisted of 186 patients. Eighty-three (45%) presented with an underlying organic condition and 103 (65%) presented with a non-organic FR; among this group, 36 patients (19.3%) presented a functional FR while in 67 (36.1%) FR appeared related to an inappropriate GERD and/or FA diagnosis and was then defined as iatrogenic. Among this subgroup of patients, FA and GERD were subsequently excluded, all therapy stopped and free diet reintroduced without any clinical problem. At discharge all children tolerated a normal diet without no therapy. At follow-up phone survey among iatrogenic subgroup patients, 93% of parents did not report any symptom evocative of GERD or FA.
Conclusion - An improper FA or GERD diagnosis may cause severe food refusal with failure to thrive. This condition has been defined as “Iatrogenic Ghost Allergy and Reflux Infant Syndrome” (IGARIS).
Parole chiave
Classificazione MeSH
Contenuto riservato
Per leggere l'articolo completo è necessario effettuare il login.
Non sei ancora registrato? Registrati
Bibliografia
1. Thommessen M, Heiberg A, Kase BF. Feeding
problems in children with congenital
heart disease: the impact of energy intake and
growth hormone. Eur J Clin Nutr 1992;46(7):
457-64.
2. Haas AM, Maune NC. Clinical presentation
of feeding dysfunction in children with eosinophilic
gastrointestinal disease. Immunol Allergy
Clin North Am 2009;29(1):65-75.
3. Böhmer CJ, Klinkenberg-Knol EC, Niezende
Boer RC, Meuwissen SG. The prevalence
of gastro-oesophageal reflux disease based on
non-specific symptoms in institutionalized, intellectually
disabled individuals. Eur J Gastroenterol
Hepatol 1997;9(2):187-90.
4. de Moor J, Didden R, Korzilius H. Behavioural
treatment of severe food refusal in five
toddlers with developmental disabilities. Child
Care Health Dev 2007;33(6):670-6.
5. Chatoor I, Ganabian J. Food refusal by infants
and young children: diagnosis and treatment.
Cogn Behav Pract 2003;10(2):138-46.
6. Ventura A. Il pediatra e il reflusso gastroesofageo.
Medico e Bambino 2009;28(4):211-2.
7. Sicherer SH, Sampson HA. Food allergy:
Epidemiology, pathogenesis, diagnosis, and
treatment. J Allergy Clin Immunol 2014;133
(2):291-307.
8. De Bruyne P, Christiaens T, Vander Stichele
R, Van Winckel M. Changes in prescription
patterns of acid suppression medications by
Belgian pediatricians: analysis of the national
data base (1997-2009). J Pediatr Gastroenterol
Nutr 2014;58(2):220-5.
9. Barron JJ, Tan H, Spalding J, Bakst AW, Singer
J. Proton Pomp Inhibitor utilization
pattern in infants. J Pediatr Gastroenterol Nutr
2007;45(4):421-7.
10. Borracino A, Ravaglia A. Prescrizione di
antiacidi, anti-H2 e IPP nei primi tre mesi di
vita nella regione Piemonte. Medico e Bambino
2014;33(10):647-51.
11. Hassall E. Over-prescription of acid suppressing
medications in infants: how it came
about, why it’s wrong, and what to do about it.
J Pediatr 2012;160(2):193-8.
12. Ferreira CT, Carvalho Ed, Sdepanian VL,
Morais MB, Vieira MC, Silva LR. Gastroesophageal
reflux disease: exaggerations, evidence
and clinical practice. J Pediatr (Rio J)
2014;90(2):105-18.
13. Putnam PE. Stop the PPI express: they
don’t keep babies quiet! J Pediatr 2009;154(4):
475-6.
14. Rosen S. Gastroesophageal reflux in infants
and children: more than just a pHenomenon.
JAMA Pediatr 2014;168(1):83-9.
15. Marchetti F. L’eccesso di diagnosi e trattamento
per il presunto reflusso gastroesofageo.
Medico e Bambino 2012;31(2):99-101.
16. Lacorte D, Alvisi P, Lambertini A, Ventura
A, Marchetti F. Il reflusso gastroesofageo: intendiamoci
sulle parole. Medico e Bambino
2016;35(2):98-102.
17. Cannioto Z, Marchetti F, Barbi E, Ventura
A. Un bambino di due anni che rifiuta il cibo e
vomita. Medico e Bambino 2006;25(5):311-14.
18. Tornese G, Cannioto Z, Marchetti F, Martelossi
S, Ventura A. IGARIS (Iatrogenic Allergy
and Reflux Infant Syndrome). Dig Liv
Dis 2009;41(S 3):211-2.
19. Rommel N, De Meyer AM, Feenstra L,
Veereman-Wauters G. The complexity of feeding
problems in 700 infants and young children
presenting to a tertiary care institution.
J Pediatr Gastroenterol Nutr 2003;37(1):75-84.
20. Levy Y, Levy A, Zangen T, et al. Diagnostic
Clues for identification of nonorganic vs organic
causes of food refusal and poor feeding. J
Pediatr Gastroenterol Nutr 2009;48(3):355-62.
21. Hassall E. Over-prescription of acid-suppressing
medications in infants: how it came
about, why it’s wrong, and what to do about it.
J Pediatr 2012;160(2):193-8.
22. Orenstein SR, Hassall E, Furmaga-Jablonska
W, Atkinson S, Raanan M. Multicenter,
double-blind, randomized, placebo-controlled
trial assessing the efficacy and safety of proton
pump inhibitor lansoprazole in infants with
symptoms of gastroesophageal reflux disease.
J Pediatr 2009;154(4):514-520.e4.
23. Moore DJ, Tao BS, Lines DR, Hirte C,
Heddle ML, Davidson GP. Double-blind placebo-
controlled trial of omeprazole in irritable
infants with gastroesophageal reflux. J Pediatr
2003;143(2):219-23.
24. Trikha A, Baillargeon JG, Kuo YF, et al.
Development of food allergies in patients with
gastroesophageal reflux disease treated with
gastric acid suppressive medications. Pediatr
Allergy Immunol 2013;24(6):582-8.
25. Meyer R, De Koker C, Dziubak R, et al.
Malnutrition in children with food allergies in
the UK. J Hum Nutr Diet 2014;27(3):227-35.
26. Longo G, Berti I, Burks AW, Krauss B,
Barbi E. IgE-mediated food allergy in
children. Lancet 2013;382(9905):1656-64.
27. Alvares M, Kao L, Mittal V, Wuu A, Clark
A, Bird JA. Misdiagnosed food allergy resulting
in severe malnutrition in an infant. Pediatrics
2013;132(1):e229-32.
28. Stark CM, Nylund CM. Side effects and
complications of proton pump inhibitors: a pediatric
prospective. J Pediatr 2016;168:16-22.
29. Lyon J. Study questions use of acid suppressors
to curb mild infant reflux. JAMA
2017;318(15):1427-8.
30. Hyman PE. Gastroesophageal reflux: one
reason why baby won’t eat. J Pediatr 1994;125
(6 Pt 2):S103-9.
31. Mathisen B, Worrall L, Masel J, Wall C,
Shepherd RW. Feeding problems in infants
with gastro-oesophageal reflux disease: a controller
study. J Paediatr Child Health 1999;35
(2):163-9.
32. Fortunato JE, Scheimann AO. Proteinenergy
malnutrition and feeding refusal secondary
to food allergy. Clin Pediatr (Phila)
2008;47(5):496-9.
33. Vandenplas Y, Rudolph CD, Di Lorenzo C,
et al.; North American Society for Pediatric
Gastroenterology Hepatology and Nutrition,
European Society for Pediatric Gastroenterology
Hepatology and Nutrition. Pediatric gastroesophageal
reflux clinical practice guidelines:
joint recommendations of the North
American Society for Pediatric Gastroenterology,
Hepatology, and Nutrition (NASPGHAN)
and the European Society for Pediatric
Gastroenterology, Hepatology, and Nutrition
(ESPGHAN). J Pediatr Gastroenterol Nutr
2009;49(4):498-547.
34. Quitadamo P, Urbonas V, Papadopoulou
A, et al. Do pediatricians apply the 2009 NASPGHAN-
ESPGHAN guidelines for the diagnosis
and management of gastroesophageal
reflux after being trained? J Pediatr Gastroenterol
Nutr 2014;59(3):356-9.
35. Canani RB, Cirillo P, Roggero P, et al. Therapy
with gastric acidity inhibitors increases
the risk of acute gastroenteritis and community-
acquired pneumonia in children. Pediatrics
2006;117(5):e817-20.
36. Taddio A, Bersanini C, Basile L, Fontana
M, Ventura A. Gastroesophageal reflux disease
at any cost: a dangerous paediatric attitude.
Acta Paediatr 2011;100(10):e178-80.
37. Parisi P, Pacchiarotti C, Ferretti A, et al.
Gastroesophageal reflux disease vs. Panayiotopoulos
syndrome: an underestimated misdiagnosis
in pediatric age? Epilepsy Behav
2014;41:6-10.
38. Sweetman LL, Ng YT, Kerrigan JF. Gelastic
seizures misdiagnosed as gastroesophageal
reflux disease. Clin Pediatr (Phila) 2007;
46(4):325-8.
39. Scherer LD, Zikmund-Fisher BJ, Fagerlin
A, Tarini BA. Influence of “GERD” label on parents’
decision to medicate infants. Pediatrics
2013;131(5):839-45.
40. Bingel U, Wanigasekera V, Wiech K, et al.
The effect of treatment expectation on drug
efficacy: imaging the analgesic benefit of the
opioid remifentanil. Sci Transl Med 2011;3
(70):70.
41. Petersen GL, Finnerup NB, Colloca L, et
al. The magnitude of nocebo effects in pain: a
meta-analysis. Pain 2014;155(8):1426-34.
Corrispondenza: andrea.taddio@burlo.trieste.it