Childhood GOR

Question 1

What is childhood GOR?

Answer 1

• non-forceful regurgitation of milk and other gastric contents into the oesophagus

Question 2

When will GOR become GORD?

Answer 2

• when reflux is persistent, more frequent and gives rise to troublesome symptoms or complications

Question 3

What age group is affected by GOR?

Answer 3

• begins before the infant is 8 weeks old
• becomes less frequent with time
• older children and adolescents

Question 4

What are the RF for GOR?

Answer 4

• Premature birth.
• Parental history of heartburn or acid regurgitation.
• Obesity.
• Hiatus hernia.
• History of congenital diaphragmatic hernia (repaired).
• History of congenital oesophageal atresia (repaired).
• Neurodisability.

Question 5

What are the presentations of GOR?

Answer 5

• heartburn
• retrosternal pain
• epigastric pain
• Recurrent regurgitation or vomiting
• episode of choking
• cough, apnoea, recurrent wheeze
• Feeding and behavioural problems
• Failure to thrive

Question 6

How would you diagnose GOR?

Answer 6

• clinically
• Ix if hx less clear or sx more severe

Question 7

What are the differential diagnosis for GOR?

Answer 7

• laryngopharyngeal reflux disease (LRD)
• congenital hiatus hernia
• gastroenteritis
• pyloric stenosis

Question 8

What are the eg of red flag sx suggesting disorders other than GOR?

Answer 8

• forceful (projectile) vomiting - hypertrophic pyloric stenosis
• Bile-stained vomit - intestinal obstruction
• Haematemesis - bleed from the oesophagus, stomach or upper gut
• Chronic diarrhoea - cow’s milk protein allergy

Question 9

What Ix would you order for GOR?

Answer 9

Only performed in severe cases

• FBC
• 24-hour ambulatory oesophageal pH study
• Barium meal
• Endoscopy - if oesophagitis suspected
• Manometry - to assess oesophageal motility and lower oesophageal sphincter function

Question 10

When would you consider performing an oesophageal pH study in infants, children and young people?

Answer 10

• Suspected recurrent aspiration pneumonia.
• Unexplained apnoeas.
• Unexplained non-epileptic seizure-like events.
• Unexplained upper airway inflammation.
• Dental erosion associated with a neurodisability.
• Frequent otitis media
• A possible need for fundoplication
• A suspected diagnosis of Sandifer’s syndrome.

Question 11

How would you mx GOR?

Answer 11

General

• reassure parents its a common condition
• review feeding hx in formula fed infants
• review red flag sx

Pharma (if simple measures fail)

• four-week trial of a PPI or H2RA

referral to a specialist for possible endoscopy if the symptoms do not resolve

Consider Enteral tube feeding to promote weight gain

Fundoplication in severe GORD

Question 12

What are the cx of GOR?

Answer 12

• Reflux oesophagitis.
• Recurrent aspiration pneumonia.
• Frequent otitis media (for example, more than three episodes in six months).
• Dental erosion - in child c neurodisability

Question 13

When would you arrange for upper GI endoscopy and biopsy?

Answer 13

• Haematemesis not caused by swallowed blood
• Melaena
• Dysphagia
• No improvement in regurgitation after the age of 1 year
• faltering growth
• Unexplained distress
• Unexplained iron-deficiency anaemia
• suspected diagnosis of Sandifer’s syndrome