Gastro-oesophageal reflux

Question 1

What is GORD?

Answer 1

Stomach reflux through LOS into oesophagus, throat and mouth

Question 2

Why is GORD more common in babies?

Answer 2

Immaturity of LOS - normal in babies to refluc feeds as long as normal frowth

Question 3

When do babies grow out of reflux?

Answer 3

90% by one year

Question 4

Problematic reflux in babies signs:

Answer 4

Chronic cough
Hoarse cry
Distress, crying or unsettled after feeding
Reluctance to feed
Pneumonia
Poor weight gain

Question 5

What symptoms of GORD do you get in children over one year old?

Answer 5

similar symptoms to adults, with heartburn, acid regurgitation, retrosternal or epigastric pain, bloating and nocturnal cough.

Question 6

Differentials for vomitting

Answer 6

• Overfeeding
• Gastro-oesophageal reflux
• Pyloric stenosis (projective vomiting)
• Gastritis or gastroenteritis
• Appendicitis
• Infections such as UTI, tonsillitis or meningitis
• Intestinal obstruction
• Bulimia

Question 7

Red flags in reflux for intestinal obstruction/pyloric stenosis

Answer 7

Not keeping any feed down
Projectile or forceful vomitting
Intestinal obstruction only:
Bile satined vomit
Abdominal distension

Question 8

What is haematemesis or melaena a red flag for in the neonate?

Answer 8

Peptic ulcer
Oesophagitis
Varices

Question 9

What signs would meningitis or raised ICP cause in the neonate?

Answer 9

Reduced consciousness, bulging fontanelle, neurological signs

Question 10

What does repiratory symptoms in a neonate suggest?

Answer 10

Aspiration
INfection
TTN

Question 11

What are signs of cows milk protein allergy in the newborn?

Answer 11

Blood in the stools (also gastroenteritis)
Rash, angioedema and other signs of allergy

Question 12

Common of infection in the newborn

Answer 12

pneumonia, UTI, tonsillitis, otitis or meningitis

Question 13

Red flags in the neonate with reflux

Answer 13

• Not keeping down any feed
• Projectile or forceful vomiting
• Bile stained vomit
• Haematemesis or melaena
• Abdominal distention
• Reduced consciousness, bulging fontanelle or neurological signs
• Respiratory symptoms
• Blood in the stools
• Signs of infection
• Rash, angioedema and other signs of allergy
• Apnoeas are a concerning feature and may indicate serious underlying pathology and need urgent assessment

Question 14

What to advise in simple baby reflux

Answer 14

Small frequent meals
Burping reguarly to help milk settle
Not overfeeding
Keep upright after feed

Question 15

What can treat problematic reflux with?

Answer 15

Gavisconmixed with feeds
Thickened milk or formula
Rnatitidne
Omeprazole (where ranitidine inadequate)

Question 16

What investigations do in severe cases of reflux?

Answer 16

Barium meal and endoscopy
Surgical funcoplication can be considered in extreme cases

Question 17

What is sandifers sundrome?

Answer 17

Breif episodes of abnormal movements ass with GORD in infants
Resolves with refluc

Question 18

Key features of sandifers syndrome

Answer 18

Torticollis
Dystonia

Question 19

What is toticollis?

Answer 19

Forceful contraction of neck muscles causing twisting of neck

Question 20

What is dystonia?

Answer 20

Abnormal muscle contractions causes by twisting movemetns, arching of back or unusual postures

Question 21

Differentials for sandifers syndrome

Answer 21

Seizures
West syndrmie

Question 22

What does gaviscon do in treatment of reflux?

Answer 22

Liquid chalk and protects oesophagus and stomach
Makes reflux less painful, wont actually stop it

Question 23

When do PPIs help in reflux in babies>

Answer 23

Helps if distressed or cryoing
Wont stop reflux

Question 24

What can carabel thickener lead to?

Answer 24

Stops reflux but can make more unsettled and cause constipation