Gastro-oesophageal reflux disease

Question 1

What is gastro-oesophageal reflux (GOR)?

Answer 1

Passage of gastric contents into the oesophagus

Question 2

When is GOR normal?

Answer 2

When asymptomatic in infants

Question 3

What is gastro-oesophageal reflux disease (GORD)?

Answer 3

Term used to describe the process in the presence of symptoms or complications of the reflux

Question 4

What is regurgitation otherwise known as?

Answer 4

Posseting

Question 5

Describe posseting

Answer 5

Reflux of stomach contents beyond the oesophagus

Question 6

What percentage of infants experience regurgitation?

Answer 6

40%

Question 7

When does regurgitation and GORD commonly present

Answer 7

Weeks 2-4 of life

Question 8

Describe the pathophysiology behind GORD

Answer 8

Lower oesophageal sphincter is responsible along with the diaphragm for preventing stomach contents to pass into the oesophagus

The lone of the oesophageal sphincter is reduced resulting in spontaneous reflux

Question 9

Describe how infant anatomy predisposes to GORD

Answer 9

Short, narrow oesophagus
Delayed gastric emptying
Shorter, lower oesophageal sphincter that is slightly above the diaphragm
Liquid and high calorie requirement
Larger ratio of gastric volume to oesophageal volume
Spending significant periods recumbent

Question 10

What are some risk factors of GORD?

Answer 10

Prematurity
Parental history of heartburn or acid regurgitation
Obesity
Hiatus hernia
History of congenital diaphragmatic hernia or congenital oesophageal atresia
Neurodisability

Question 11

What questions would you want to ask about in a GORD history?

Answer 11

Distressed behaviour 
Unexplained feeding difficulties 
Hoarseness/chronic cough in older children 
Single episode of pneumonia
Faltering growth 
Retrosternal or epigastric pain 

Full feeding history - position, attachment, technique, duration, frequency, type of milk. Calculate the volume being given.

Frequency and amount of vomits, relationship of vomits to feeding

Question 12

What would you look for on examination in GORD?

Answer 12

Hydration status
Signs of malnutrition
Any abnormalities indicating a differential - atopy
Growth charts - look for faltering growth

Question 13

What is the differential diagnosis for GORD?

Answer 13

Pyloric stenosis
Intestinal obstruction
Acute surgical abdomen issue 
Upper GI bleed
Sepsis 
Raised ICP
Bacterial gastroenteritis
Cows milk allergy 
UTI

Question 14

Describe the management of GORD in breast fed baby

Answer 14

Alginate (eg. Gaviscon) mixed with water immediately after feeds for 2 weeks
If no improvement then PPI or histamine antagonist (omeprazole or ranitidine)
Paediatric referral and reconsider differentials

Question 15

Describe the management of GORD in a formula fed baby

Answer 15

Check volume of feeds - ensure not overfeeding
Reduce volume of feeds by increasing frequency
Use feed thickener
Stop thickener and start alginate therapy - 2 week trial
If no improvement then PPI or histamine antagonist (omeprazole or ranitidine)
Paediatric referral and reconsider differentials

Question 16

What percentage of infants will GORD resolve in within the first year of life?

Answer 16

90%

Question 17

List some uncommon complications of GORD in children

Answer 17

Reflux oesophagitis
Recurrent aspiration pneumonia
Recurrent otitis media 
Dental erosion 
Apnoea 
Apparent life threatening events