Gastrooesophageal reflux

Question 1

Gastrooesophageal reflux

Answer 1

Common, especially in infants
Physiological in infancy
Contributory factors include more frequent relaxation of lower oesophageal sphincter, liquid feeds and supine posture

Question 2

Those at risk of severe gastrooesophageal reflux

Answer 2

Preterm infants, especially those with chronic lung disease
Children with cerebral palsy
Infants with congenital oesophageal abnormalities

Question 3

Clinical features

Answer 3

Symptoms usually mild (regurgitation/posseting)
In some, symptoms are severe and may lead to complications such as failure to thrive, oesophagitis, aspiration pneumonia, cough, bronchospasm (with wheezing) and bronchiectasis
Manifestations of oesophagitis: irritability, pain after feeding, blood in vomit, iron-deficiency aneamia

Question 4

Diagnosis

Answer 4

Mostly clinical
To confirm:
24 hour oesophageal pH monitoring in older children or impendance studies in infants
Barium studies - to exclude underlying anatomical abnormalities
Endoscapy: indicated in patients with suspected oesophagitis

Question 5

Management

Answer 5

Mild: reassurance, 95% spontaneous resolution by 18 months
Mod: thickening feed with inert carob-based agents
Severe: Prokinetic drugs eg domperidone; drugs to reduce gastric acid secretion (H2 agonists or PPIs), especially if evidence of oesophagitis
Very severe with complications: Surgery, most commonly Nissen fundoplication (fundus of stomach wrapped around lower oesophagus)