***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND About 20 % of infants fed with breast-milk substitutes  suffer from Gastro Esophageal Reflux ( GER ) and 1/3 of them also show Cow 's Milk Allergy ( CMA ) symptoms . METHODS We planned this study to assess by dynamic echography the usefulness of an Extensively Hydrolysed Cow 's Milk Formula ( eHF ) in infants suffering from GER . Ten infants showing GER symptoms and 10 normal babies , all fed with breast-milk substitutes , were enrolled .  Clinical symptom scores related to GER were assessed for one week . The Gastric Emptying Time ( GET ) was determined by means of dynamic echography after feeding with cow 's milk-derived formulae and again after a week feeding with eHF in subjects previously showing GER symptoms . RESULTS All infants with a clinical diagnosis for GER showed an abnormally high average GET in comparison to normal subjects ( 205 vs 124 min , p = 0.000 ) . Switching to the eHF led to a significant clinical improvement ( p = 0.0039 ) especially in babies skin-test and RAST positive to cow 's milk , and to a significant decrease toward the normal value of the GET ( 167 min , p < 0.001 ) . CONCLUSIONS The eHF tested improves GER symptoms in infants suffering from this disease . Our experience confirms and supports the use of dynamic echography as a reliable , simple , and non-invasive diagnostic method for infants with an increased GET associated with clinical symptoms of GER ABSTRACT : Casein-predominant infant milk formulas have been speculated to predispose to lactobezoar formation in preterm infants due to delayed gastric emptying . There have been , however , no prospect i ve studies to prove this possi-bility . In a r and omized , double-blinded , prospect i ve study , we tested the hypothesis that preterm infants fed casein-predominant milk formula  have slower gastric emptying than infants fed whey-predominant formulas . Twenty pre-term infants within the first 4 d of life were r and omized to receive either the  whey-predominant formula Similac Special Care ( whey : casein ratio 60:40 ) or an experimental casein-predominant formula ( whey : casein ratio 18:82 ) . Only the protein composition differed between the two formulas . The infants were fed the assigned study formula until they reached approximately 2200 g body weight when a gastric emptying scan was performed , using the design ated study formula mixed with 25 μCi of technetium-99 sulfur colloid . Gastric emptying was followed continuously for 2 h. Gastric emptying at 30 , 60 , 90 , and 120 min was similar between the two study groups . The time for 50 % gastric emptying was 64.9 ± 12.3 min for the infants fed the whey-predominant formula and 56.5 ± 14.8 min for those fed the casein-predominant formula ( p = 0.75 ) . We conclude that the rate of gastric emptying in preterm infants fed casein-predominant formulas is similar to that in those fed whey-predominant formulas BACKGROUND & AIMS Gastric emptying ( GE ) is influenced by the type of nutrition . The objective of this study was to compare GE in infants fed an intact protein formula ( IPF ) , a partially hydrolysed formula ( PHF ) , and an extensively hydrolysed formula ( EHF ) .  METHODS This was a double-blind , r and omized , cross-over study . Following a fasting period of > or = 3 h , 20 healthy newborns were fed IPF , PHF , and EHF containing 50 microl (13)C-octanoic acid ( OA ) . Breath sample s were taken before feeding and every 15 min for 4 h thereafter . (13)C-OA  breath test was assessed by isotope-ratio mass spectrometry , and GE half-times ( t(1/2 ) ) were determined . RESULTS Seventeen infants with a mean gestational age of 37 wk ( range 28 - 40 wk ) and birth weight of 2698 g ( range 720 - 3690 g ) completed the study . At study initiation , the mean age was 31 d ( range 6 d-13 wk ) and the mean weight was 3466 g ( range 2100 - 5700 g ) . EHF emptied significantly faster than IPF and PHF ( medians 46 vs. 55 and 53 min , respectively , Wilcoxon , P<0.05 for both ) . There was no significant difference between GE of PHF and IPF ( Wilcoxon , P=0.2 ) . CONCLUSIONS EHF may be better tolerated by infants with GE problems Summary The role of delayed gastric emptying ( GE ) in the pathogenesis of gastroesophageal reflux ( GER ) in infants is controversial at present . GE has been shown to be altered by the composition and osmolality of the feedings . This prospect i ve study was undertaken to assess the changes in the GE and the percentage of time GER was detected by scintigraphy using three different formulas on consecutive days in infants with GER . Twenty-eight infants under 1 year of age diagnosed to have GER by extended intraesophageal pH monitoring ( pH being < 4.0 for > 5 % of the duration of the test ) , underwent scintigraphy on three consecutive days using the same volume per single feeding of a casein-predominant , soy , or a wheyhydrolysate formula in a r and omized order . The formulas were isocaloric . Gastric emptying and percentage of GER into the esophagus were estimated for 60 min following these feedings . Mean GER percent during the study was 20.39 , 17.68 , and 16.34 on casein-predominant , soy , and whey-hydrolysate formulas , respectively , and was not significantly different . Mean values of GE were 39.7 % , 44.6 % , and 48.5 % on casein , soy , and whey formula , respectively . No significant difference in GE was also observed between casein-predominant and soy formula . However , a significant difference was observed ( p < 0.05 ) on GE between casein-predominant and whey-hydrolysate feedings . Our data suggest that formula selection may be important in the treatment of conditions associated with delayed gastric emptying The present study was design ed to determine the effects of milk composition and the influence of  gastro-oesophageal reflux ( GOR )  on gastric emptying .  Cineoesogastrocintigraphy ( COGS ) was performed in 201 infants between 0 - 1 year of age in order to detect GOR , and provided a means of estimation of the gastric emptying ( GE ) .  Ninety infants appeared free from GOR and constituted the control group ; 111 had GOR . There infants were fed human milk or various st and ard formulae . In addition , 20 infants fed a whey-hydrolysate formula were tested . An appropriate volume of milk was marked with sulfur-colloid Tc ( 200 microcuries ) . Measurements of gastric radioactivity were made 30 min and 120 min after ingestion . For the whole population , the infants with GOR had slightly more rapid GE after 30 min ( P less than 0.05 ) , but , for the same type of milk , there was no significant difference between GOR and controls . GE did not differ with age or sex , but differed mainly according to the type of milk . In the control group , gastric residual content ( GRC ) at 120 min was 18 + /- 11 per cent with human milk ( n = 7 ) , 16 + /- 21 per cent with whey-hydrolysate formula ( n = 8) , 25 + /- 17 per cent with acidified formula ( n = 13 ) , 26 + /- 19 per cent with whey-predominant formula ( n = 22 ) , 39 + /- 17 per cent with casein-predominant formulae ( n = 20 ) , 47 + /- 19 per cent with follow-up formulae ( n = 16 ) and 55 + /- 19 per cent with cow 's milk ( n = 12 ) . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND & AIM Dysmotility , nausea and vomiting are common among children with cerebral palsy . This study aim ed to evaluate influence of protein composition on rate of gastric emptying and study the relation between gastric emptying and postpr and ial gastrointestinal symptoms . METHODS 15 children with cerebral palsy , using gastrostomy , received four liquid test meals on separate days in r and om order . The meals contained a st and ard carbohydrate and fat base plus one of four protein modules ( 100 % casein ( A ) , hydrolysed whey ( B ) , amino acids ( C ) and 40 % casein/60 % whey ( D ) ) with a total energy of 1 kcal/ml . The (13)C octanoic acid breath test  was applied to assess gastric emptying . RESULTS When comparing half emptying time ( T(1/2 ) ) of the fast emptying meals ( meal B , C and D ) with the slowest emptying meal ( meal A ) , more rapid emptying was demonstrated for meal D ( p < 0.001 ) . For meal D , emptying was significantly faster in children with postpr and ial symptoms than in those without ( p < 0.01 ) . CONCLUSION In children with cerebral palsy using gastrostomy , gastric emptying is influenced by type of protein in the meal . The present results also suggest that there is a relation between rapid gastric emptying and postpr and ial gastrointestinal symptoms . CLINICAL TRIALS.GOV : UUSKBK 28200706 BACKGROUND & AIMS The aim was to study the influence of Nissen fundoplication on rate of gastric emptying and postpr and ial symptoms in relation to protein source in liquid meals in children with cerebral palsy . METHODS Ten children with cerebral palsy and Nissen fundoplication and ten with cerebral palsy without Nissen fundoplication were studied . Patients had gastrostomy and received two meals , double-blinded , in r and om order , on separate days . Meals contained a st and ardised carbohydrate and fat base plus one of two protein modules ( Meal A : 100 % casein ; Meal B : 40 % casein/60 % whey ) . The  (13)C octanoic acid breath test  was used to assess gastric emptying . Postpr and ial symptoms were recorded . Results are given as median . RESULTS For meal A and B , respectively , time until 50 % of the meal had emptied ( T1/2 ) was 110 in the Nissen fundoplication- and 181 min in the non-Nissen fundoplication group , ( p = 0.35 ) and 50 and 85 min ( p = 0.25 ) . Seven in the Nissen fundoplication group reported postpr and ial symptoms to meal B , none in the non-Nissen fundoplication group ( p < 0.01 ) . CONCLUSIONS Compared with cerebral palsy-children without Nissen fundoplication , those with Nissen fundoplication have postpr and ial symptoms more frequently after receiving a rapid emptying meal . Gastric emptying alone , however , does not seem to explain the symptom occurrence . Clinical Trials.gov : UUSKBK 28200706 
    Output:
    
Conclusions Breast milk has a faster GE than formula milk .