GERD

Question 1

Answer 1

Question 2

Pathologic GERD occurs in ___% of adults & 1-4 % of children

Answer 2

5%

Question 3

True or False Physiologic GER is more common in infants?

Answer 3

True

Question 4

▪ About 50% of infants have recurrent vomiting in first 3 months, 67% of 4-month-olds, 5% of 10-12-month-olds.

Answer 4

▪ Incident even higher in premature babies and the neurologically impaired

Question 5

History Taking Infants GER/GERD?

Answer 5

▪ Feeding type, volume, and frequency?
▪ Position placed after feeding?
▪ Regurgitation quality and timing. Baby cry with regurgitation?
▪ Reoccurring respiratory illnesses/symptoms including PNA, obstructive apnea, cough, stridor, wheezing?

Question 6

History taking children GER/GERD?

Answer 6

▪ Frequency, timing of symptoms?
▪ Abdominal pain, location, timing, frequency, quality?
▪ Specific foods consumed prior to symptoms?
▪ Diet history, type, amount, beverages, alcohol?
▪ Dysphagia, food lodging, chronic throat clearing

Question 7

Question 8

Physical Findings for GER/GERD?

Answer 8

▪ May be normal.

▪ Failure to thrive/Growth failure
▪ Abdomen: Epigastric tenderness.
▪ Mouth: Possible enamel erosion or dental caries (not necessarily linked to GERD)
▪ Anemia, hematemesis, melena (uncommon)

Question 9

Diagnostic tests for GER/GERD?

Answer 9

▪ No gold standard diagnostic to diagnose GERD

▪ Upper GI series: To rule out anatomic abnormalities
▪ Indicated in infants with forceful/projectile vomiting
▪ Indicated in older children with frank vomiting,
dysphagia
Occult blood: Positive may indicate esophagitis

Question 10

Differential dx for GER/GERD?

Answer 10

▪ Gastritis
▪ Milk/soy protein allergy

▪ Pyloric stenosis
▪ Polyphagia
▪ Helicobacter pylori
▪ Celiac disease
▪ Intussusception
▪ Several others

Question 11

GER VS GERD

Answer 11

▪ If “Happy Spitter” with no other systemic complaints or symptoms – likely GER and non pharmacologic interventions appropriate.

▪ If systemic symptoms or concerns arise – likely GERD: poor weight gain, fussy, etc – pharmacologic interventions needed.

Question 12

Answer 12

Question 13

Question 18

Surgery for GERD?

Answer 18

▪ Fundoplication. Reserved for severe GERD that failed medical management.

Question 19

What are the goals of treatment for GERD?

Answer 19

▪ Relieve symptoms
▪ Promote normal weight gain and growth
▪ Heal inflammation (esophagitis)
▪ Prevent respiratory and other complications

Question 20

What is the plan for follow up for GERD?

Answer 20

▪ Follow up after 2 weeks of H2 blocker, or PPI.
▪ Return to clinic for increased symptoms, new symptoms.
▪ Refer to pediatric GI specialist if symptoms severe/no response to treatment or lifestyle changes.