1IRCCS Materno-Infantile “Burlo Garofalo”, Trieste
2Università di Trieste 3UOC di Pediatria, Ospedale di Ravenna, AUSL della Romagna
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Key words: IGARIS, Food Adversion, Gastroesophageal Reflux, Food Allergy, Failure to thrive
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
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).
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