A former full-term 17-month-old boy is referred to the pediatric gastrointestinal (GI) clinic by his pediatrician for vomiting. He has 4 to 5 episodes weekly of nonbloody, nonbilious emesis after gagging on solid or textured foods. His parents report that he has never been able to eat solid foods but that he swallows liquids and pureed foods easily. His diet consists of whole milk and pureed foods. Bowel movements are normal. He does not have any medical or surgical history, with good growth, development, and weight gain. He does not take any medications and has no allergies. His family history is noncontributory.

Physical examination reveals an obese child who is otherwise normal. His initial laboratory evaluation is normal for complete blood cell count with differential count, tissue transglutaminase IgA, and total IgA. Radioallergosorbent test results are low positive for milk at Class 2, which is not clinically significant. A scout...

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