Gastroenterology: GORD Flashcards
What is GORD?
The involuntary passage of gastric contents into the oesophagus
It the commonest cause if vomiting in infancy. True or false?
True
Is there a degree of overlap with normal physiological processes?
Yes around 40% of infants regurgitate there feeds to a certain extent
Among what age is it common?
1st year of life
Nearly all symptomatic reflux resolves spontaneously by 12 months
What causes it?
Inappropriate relaxation of the lower oesophageal sphincter as a result of functional immaturity
What factors contribute to gastro-oesophageal reflux in infancy?
Predominantly fluid diet
Mainly horizontal posture
Short intra-abdominal length of oesophagus
Why does the majority of cases resolve by 1 year?
Maturation of LOS
Assumption of upright posture
More solids in diet
Do most infants with gastro-oesophageal reflux put on weight normally and are they otherwise well?
Yes
Is gastro-oesophageal reflux usually benign and self limited?
Yes , but when it becomes a significant problem it becomes gastro-oesophageal reflux disease and needs treatment
GORD is more common in…
Children with cerebral palsy or other neurodevelopmental disorders
Preterm infants especially those with bronchopulmonary dysplasia
Following surgery from oesophageal atresia or diaphragmatic hernia
What symptoms are seen with GOR?
Recurrent regurgitation or vomiting
What complications of GOR can occur ie GORD?
Faltering growth from severe vomiting
Oesophagitis - haematemesis, discomfort on feeding or heartburn, iron deficiency anaemia
Recurrent pulmonary aspiration - recurrent pneumonia, cough or wheeze, apnoea in preterm infants
Dystonic neck posture
Frequent otitis media
In older children: dental erosion
With GOR, before what age does it usually start?
Before 8 weeks
Peaks at 4-6 months
Improves by 12 months
How is GOR diagnosed?
Clinically and no investigations required
When may investigations be indicated?
If history is atypical, complications present, failure to respond to treatment
What investigations can be done if indicated?
24 hour oesophageal pH monitoring to quantify degree of acid reflux
24 hour impedance monitoring is available in some centres. Weakly acidic or nonacid reflux, which may cause disease, also measured
Endoscopy with oesophageal biopsies to identify oesophagitis and exclude other causes of vomiting
What may be useful to exclude underlying anatomical abnormalities in oesophagus, stomach, duodenum and identify maleotation?
Contrast studies of upper GI tract
How is uncomplicated gastro-oesophageal reflux managed?
Parental reassurance - it has an excellent prognosis
Position of feeding: 30 degrees with head up
Infants should sleep on back as per standard guidance
Ensure infant not over fed and consider trial of smaller and more frequent feeds
Add thickening agents to feeds e.g carobel
Significant GORD can be managed with…
Trail of alginate therapy e.g graviscon (not at same time as thickening agents)
PPI (omeprazol) or H2 receptors antagonist (ranitidine) - consider a trial of one of these if unexplained feeding difficulties, distressed behaviour, faltering growth
Why is the evidence poor for the use of enhanced gastric emptying drugs e.g domperidone?
They are associated with significant side effects - their use should be discouraged
If a child fails to respond to treatment, what should be considered?
Other diagnoses e.g cow’s milk protein allergy
What is surgical management reserved for?
Children with complications unresponsive to intensive medical treatment or oesophageal stricture.
What is the surgical procedure that can be done if indicated?
A Nissen fundoplication - fundus of stomach wrapped around the intra abdominal oesophagus
