GI - GORD

Question 1

Definition

Answer 1

Where contents from the stomach reflux through the lower oesophageal sphincter into the oesophagus, throat and mouth

Question 2

Pathophysiology

Answer 2

There is immaturity of the lower oesophageal sphincter allowing stomach contents to easily reflux into the oesophagus.
It is normal for a baby to reflux feeds and provided there is normal growth baby is well = not a problem.
This usually improves as they grow and 90% of infants stop having reflux by 1 year

Question 3

Signs and symptoms of problematic reflux include

Answer 3

Chronic cough
Hoarse cry
Distress, crying, or unsettled feeding
Reluctance to feed
Pneumonia
Poor weight gain

Question 4

Children over 1 symptoms

Answer 4

Children over one may experience similar symptoms to adults with:
Heart burn
Acid regurgitation
Retrosternal or epigastric pain
Bloating
Nocturnal cough

Question 5

Causes of vomiting

Answer 5

Vomiting = very non specific and is often non indicative of underlying pathology. Possible cause:
- Over feeding
- GORD
- Pyloric stenosis (projective vomiting)
- Appendicitis
- Infections such as UTI, tonsillitis, or meningitis
- Intestinal obstruction
- Bulimia

Question 6

Red flag signs

Answer 6

Not keeping down ANY food = pyloric stenosis or intestinal obstruction
Projectile or forceful vomiting = pyloric stenosis or intestinal obstruction
Bile stained vomit = intestinal obstruction
Haematamesis or melaena = peptic ulcer, oesophagitis, varices
Abdominal distention = intestinal obstruction
Reduced consciousness, bulging fontanelle or neurological signs = meningitis or raised ICP
Respiratory symptoms = aspiration and infection
Blood in the stools = gastroenteritis or cows milk protein allergy
Signs of infections = pneumonia, UTI, tonsillitis, otitis or meningitis
Rash, angioedema or other signs of allergy = cows milk protein allergy
Apnoea = concerning feature and may indicate serious underlying pathology and need urgent assessment

Question 7

Treatment

Answer 7

Simple cases = Advice
- small frequent meals
- burping regularly to help milk settle
- not over-feeding
- keep the baby upright after feeding

More problematic cases =
- gaviscon mixed with feeds
- thickened milk or formulae (specific anti-reflux formulas are available)
- PPI (omeprazole) where other methods are inadequate

RARELY = severe cases = further investigations
= barium meal and endoscopy
= surgical fundoplication = very severe cases and rarely required or performed

Question 8

Sandifer’s sydrome

Answer 8

Rare condition = brief episodes of abnormal movements. Associated with GORD in infants. Infants usually neurologically normal. Key features:
- Torticollis: forceful contraction of the neck muscles causing twisting of the neck
- Dystonia: abnormal muscle contraction causing twisting movements, arching of the back or unusual postures
Tends to resolve as reflux is treated/improves.
Refer to specialist as differential diagnosis serious conditions e.g. infantile spasms and seizures