15. GOR

Question 1

Discuss the pathophysiology of GORD

Answer 1

Gastric acid from the stomach leaks up into the oesophagus

Lower oesophageal sphincter controls passage of contents from oesophagus to stomach = episodes of sphincter relaxation are more frequent = reflux

= mucosal damage

Question 2

What are the risk factors for GORD

Answer 2

Prematurity

Obesity

FH of heartburn

Hiatus hernia

Congenital diaphragmatic hernia

Neurodisability (CP)

Question 3

How does GORD present?

Answer 3

• distressed behaviour
• feed diff
• hoarseness/chronic cough
• faltering growth
• single episode pneumonia
• retrosternal or epigastric pain

Question 4

What investigations should be performed when GORD is suspected?

Answer 4

No Ix require to Dx reflux

Question 5

How is GORD best managed?

Answer 5

Effortless regurgitation = no intervention, reassurance key

Breastfed + regurgitation = alginate (gaviscon) mixed with water post feed

Formula-fed + regurgitation =

1) ensure not over-fed (<150ml/kg/d total milk)
2) decrease feed vol by increasing frequency (2-3h)
3) feed-thickener
4) stop thickener start gaviscon added to formula

If no improvement after alginate 2w = omeprazole/ranitidine

Question 6

Name the possible complications from GORD

Answer 6

Uncommon

• reflux oesophagitis
• recurrent aspiration pneumonia
• recurrent otitis media
• dental erosion

Rare
- apnoea