Gastro-oesophageal Reflux Flashcards
What is gastro-oesophageal reflux?
The involuntary passage of gastric contents into the oesophagus
Is gastro-oesophageal reflux usually a problem?
No, it is usually a benign self-limiting problem
When does gastro-oesophageal reflux become more serious?
When it progresses to GORD and requires treatment
When is gastro-oesophageal reflux common?
In infancy
When should infantile gastro-oesophageal reflux usually resolve by?
12 months of age
What can cause the development of gastro-oesophageal reflux?
- Inappropriate lower oesophageal sphincter relaxation
- Predominantly fluid diet
- Mainly horizontal posture
- Short intra-abdominal lenght of oesophaus
What are the risk factors for gastro-oesophageal reflux?
- Cerebral palsy
- Other neurodevelopmental disorders
- Pre-term
- Following surgery for oesophageal atresia or diaphragmatic herniation
What are the symptoms of gastro-oesophageal reflux?
Recurrent regurgitation or vomiting
How would you expect gastro-oesophageal reflux to affect the infant systemically?
Putting on weight and otherwise well
How is gastro-oesophageal reflux typically diagnosed?
Clinically
When may further investigations be indicated?
- Atypical history
- Complications present
- Treatment failure
What investigations can be used in assessment of gastro-oesophageal reflux?
- 24 hours oesophageal pH monitoring
- Endocsopy with biopsy
- Contrast studies
What is a 24 hour oesophageal pH monitoring test used for?
To assess the degree of reflux
What is the purpose of endoscopy and biopsy?
To assess for oesophagitis and exclude other causes of vomiting
What is the purpose of contrast studies?
To exclude underlying anatomical abnormalities in the oesophagus, stomach and duodenum
What are the differentials for gastro-oesophageal reflux?
- Upper GI tract disorders
- Cows milk intolerance
- Metabolic disorders
- CNS disorders
- Urinary tract disorders
What upper GI tract disorders may present like gastro-oesophageal reflux?
- Pyloric stenosis
- Malrotation
- PUD
What metabolic disorders may cause recurrent vomiting?
- Renal tubular acidosis
- Urea cycle defects
What CNS disorders may present with recurrent vomiting?
- Hydrocephalus
- Meningitis
What urinary tract disorders may present with recurrent vomiting?
- Infection
- Obstruction
How is uncomplicated gastro-oesophageal reflux usually managed?
Conservatively
What conservative management techniques can be used in gastro-oesophageal reflux?
- Parental reassurance
- Adding inert thickening agents to feeds
- Giving smaller, more frequent feeds
What type of treatment does significant GORD require?
Medical management and - possibly surgical management
What types of medications can be used in the treatment of GORD?
- H2 antagonists
- PPI’s
Give an example of a H2 antagonist
Ranitidine
Give an example of a PPI
Omeprazole
What should failure to respond to medical management prompt?
Reconsideration of diagnosis
When should surgical management be considered?
In children with complications unresponsive to medical treatment or oesophageal stricture
What surgical procedure is used in the correction of gastro-oesophageal reflux?
Nissen fundoplication
What are the potential complications of gastro-oesophageal reflux?
- Faltering growth due to severe vomiting
- Oesophagitis
- Recurrent pulmonary aspiration
- Dystonic neck posturing
What are the symptoms of oesophagitis?
- Haematemesis
- Heartburn on feeding
- Iron-deficiency anaemia
What are the symptoms of recurrent pulmonary aspiration?
- Recurrent pneumonia
- Cough
- Wheeze
