Gastro-oesophageal reflux disease in children Flashcards
What is the definition of gastroesophageal reflux
Functional or physological process in a healthy infant
Involves regurgitation, which is the passive return of gastric contents retrograde into the esophagus
What is the definition of gastroesophageal reflux disease
Pathological process
Characterised by poor weight gain, signs of esophagitis, persistent respiratory symptoms and changes in neurobehavior
What are the clinical features of GOR and GORD
GOR:
- Regurgitation with normal weight gain
- No signs or symptoms of oesophagitis
- No significant respiratory symptoms
- No neurobehavioral symptoms
GORD:
- Regurgitation with poor weight gain
- Resistant irritability in infants, pain in children
- Apnea and cyanosis, wheezing, aspiration, recurrent pneumonia, chronic cough, stridor
- Neck tilting in infants (Sandifer’s syndrome)
What is the management of GOR
Reassure parents
Thicken feeds
Frequent small feeds
Upright position after feeds
Management of GORD
Rule out other diseases
Emperic medical therapy if clinical suspicion for GORD: Gaviscon, PPI
Special confirmatory investigations
What are the differential diagnosis for vomiting child
GIT: Pyloric stenosis, malrotation, cows milk allergy, peptic ulcer disease, hepatitis, eosinophilic oesophagitis
Urinary tract: Infection, Obstruction
CNS: Hydrocephalus, Meningitis
Metabolic disorders: Renal tubular acidosis, hypocalcemia, hypothyroidism
Functional: Rumination, Anorexia
What are the indications for surgery
If persistent in spite of medication
Atyical (especially respiratory) symptoms
Complications of GORD: aspiration, stricture, Berrett’s
Apparent life threatening episode associated with GORD
Patients with neurological impairment and reflux requiring feeding gastrostomy
What is the surgical technique used for GORD
Nissen fundoplication (360 degree)
Laparoscopic Nissen is equal to open procedure but patient has shorter recovery time
