Gastro-Oesophageal Reflux

Question 1

What is GOR?

Answer 1

Gastro-oesophageal reflux

Passage of gastric contents into the oesophagus

Question 2

What is GORD?

Answer 2

Gastro-oesophageal reflux disease

Presence of symptoms of oesophagitis

Question 3

What is regurgitation?

Answer 3

Reflux of stomach contents beyond the oesophagus

Question 4

What percentage of infants will experience regurgitation?

Answer 4

40%

Question 5

When does regurgitation/GORD first appear?

Answer 5

2 weeks

Question 6

Why do infants get GORD?

Answer 6

Lower oesophageal sphincter is not well formed
- low tone

Short, narrow oesophagus

High pressure between stomach + oesophagus

Question 7

What are risk factors for developing GORD?

Answer 7

Prematurity 
Parental history of heartburn/GORD
Obesity 
Neurodisability
Hiatus hernia

Question 8

What are symptoms of GOR?

Answer 8

Vomiting after feeds

Symptoms worse lying down

Question 9

What are symptoms of GORD?

Answer 9

Irritability 
Vomiting 
Pain
Feeding difficulities
Growth problems

Question 10

What are key points in a feeding history?

Answer 10

Volume of milk given (may be overfed)
Frequency of feeds
Position of feeding
Content of feeds
Relationship of symptoms to feeds

Question 11

What age does GOR normally stop?

Answer 11

6 months

Question 12

How is GOR managed?

Answer 12

Feeding plan

• smaller feeds
• more frequent feeds

Feed thickener

Add alginate

Question 13

What is the total amount of milk an infant should have?

Answer 13

150ml/kg/day

Question 14

How is GORD managed?

Answer 14

1st line - ensure infant is not overfed
2nd line - reduce volume by increasing frequency 
3rd line - use thickener
4th line - add alginate
5th line - PPI trial