Gastro - GORD

Question 1

What is the pathophysiology of GORD? Contributing factors?

Answer 1

Inappropriate relaxation of lower oesophageal sphincter due to functional immaturity.

Extremely common in infancy

Other contributing factors are:
Liquid diet
Slow gastric empyting
Horizontal posture
Short intra-abdominal length of oesophagus

Question 2

How is uncomplicated GORD managed?

Answer 2

Parenteral reassurance

Add inert thickening agents to feeds (eg. Nestargel)

Small frequent meals

Position in a 30° head-up position after feed

Question 3

How is significant GORD managed? (medical)

Answer 3

Acid suppression with:

H2 receptor antagonists (ranitidine)
OR
PPIs (omeprazole)

Gaviscon (antacid, alginate)

There is poor evidence for drugs enhancing gastric emptying (domperidone) but they can be used

Question 4

What surgery can be performed to relieve severe GORD?

Answer 4

Surgical management is reserved for children with complications:
Indications :
-unresponsive to intensive medical treatment
-oesophageal stricture
-severe oesophagitis
-recurrent apnoea

Nissen fundoplication

Fundus of the stomach is wrapped around the intra-abdominal oesophagus (abdominal or laparoscopic)

Question 5

What are the rare complications of GORD?

Answer 5

Life-threatening apnoea leading to SIDS (sudden infant death syndrome)

Choking and gagging from aspiration

Reflux oesophagitis leading to Barrett’s oesophagus

Faltering growth

Dysphagia from oesophageal stricture

lower respiratory disease from aspiration

Question 6

Differentials to GORD (reflux is very common in infancy)

Answer 6

LOS dysfunction - hiatus hernia
Gastric hypersecretion - acid
Food allergy
Cerebral palsy

Question 7

Presentation of GORD

Answer 7

Regurgitation
Irritability
Oesophagitis (haematemesis, difficulty feeding)
Faltering growth

Apnoea, hoarseness, cough, stridor
Aspiration pneumonia