Today, I came across an online post that was written by a mother of a child with food allergies. She wrote, "Many doctors have now told me that FPIES and reflux are not related. I don't believe it. Are there resources with proof out there?" In response, I told her, "You are both right. This is such a complex topic that I can't answer it by writing a Facebook post. Instead, can I do a podcast about it?" Hence this podcast episode was born. Now, if the mom of this podcast is listening or if you find it helpful, please, rate my podcast. Give it five stars for good measure! Good ratings on a podcast allow it to be seen by more people and allow me to help more people.
Back to the topic at hand... I understand where the doctors are coming from when they say, "No! FPIES and reflux are not related." They might have only 10 to 15 minutes to see you in the office, and the actual answer is way more complex. They just don't have the time to go over all of it in great detail. Yes, the doctors are right that FPIES and reflux in some ways when they say that these two conditions are not related. However, they would be even more right if they said, "Food allergies including FPIES and reflux are not related in some ways, but they also are related in other ones." That's an even more accurate statement, but explaining the reasons for it would take a long time! More than the length of a podcast episode but at least here you'll get a partially complete answer!
In this episode, I'm first going to go over some of the similarities between reflux and food allergies.
One of the first similarities is food moving in reverse through the digestive tract. It's kind of like skydiving. The airplane is on its way up from the ground, and you jump out of the perfectly good airplane to go fly way back down to the ground. When you vomit, food that was on its way further down the digestive tract goes straight back from where it came! Up and out of the mouth! However, vomiting food is much less fun than skydiving !
According to the Mayo Clinic, one of the symptoms of reflux is "regurgitation of food or sour liquid." In other words, one of the symptoms of reflux is food being brought back up from the stomach into the mouth. How about one of the symptoms of food allergies? It's the same thing. Without food being ejected from the stomach... without vomiting... you cannot be diagnosed with acute FPIES or acute food protein-induced enterocolitis syndrome. In fact, vomiting can be a sign of multiple types of food allergies - not just FPIES. People with classic IgE-mediated food allergies can also vomit.
Remember little Peter whose mom took him to see the doctor for recurrent episodes of vomiting? The doctor heard the phrase "distressing vomiting" or "little kid vomiting that is bothering the mother" and thought, "Hmm.... what's one of the common diagnoses that can do this? I need something that I can treat more easily before I do a complex workup... Oh... I got it... Reflux! Why don't we see if this is gastroesophageal reflux and prescribe a histamine 1 blocker for Peter? Let's see what happens if we do this."
The problem is that histamine 1 blockers do not stop vomiting. Instead, they might make vomiting less painful on the esophagus. However, they do not stop vomiting. Now you might be asking yourself, "If histamine 1 blockers do not stop vomiting, what does?"
The answer here is that it depends upon the reason for the vomiting. It's not all about the reflux. There are many reasons why young children vomit, and you need to try to figure out the root cause so that you can then develop the appropriate treatment plan.
Take FPIES, for instance. It's a condition can be diagnosed when a person vomits approximately 1 to 4 hours after eating a trigger food and has a set of other symptoms including paleness to the skin and fatigue. The amount of time can vary as can the other symptoms. In FPIES, vomiting happens after the immune system recognizes a specific food as being foreign to the body. The immune system says, "I'm going to do something to get rid of this trigger food. I'm going to make sure that the digestive tract releases a lot of serotonin". Cells in the digestive tract then release a chemical messengers including serotonin as well as some other ones. (The jobs of these chemical messengers is to trigger the vomiting reflex.) When there's too much serotonin or another one of these chemical messengers during an allergic reaction, vomiting happens. You treat an acute FPIES reaction by giving odansetron. It blocks the effects of serotonin. The vomiting in FPIES happens partly because of changes in serotonin levels.
How about with reflux? What causes vomiting with reflux?
That's a great question, and I will give you more information about it in the next blog post (#057).
This episode is part of the