GOR

Question 1

Discuss the pathophysiology of GORD

Answer 1

Gastric acid from the stomach leaks up into the oesophagus

Lower oesophageal sphincter controls passage of contents from oesophagus to stomach = episodes of sphincter relaxation are more frequent (functional immaturity) = reflux

= mucosal damage

Question 2

What are the risk factors for GORD

Answer 2

Prematurity

Obesity

FH of heartburn

Hiatus hernia

Congenital diaphragmatic hernia

Neurodisability (CP)

Question 3

How does GORD present?

Answer 3

• distressed behaviour
• feed diff
• hoarseness/chronic cough
• faltering growth
• single episode pneumonia
• retrosternal or epigastric pain

Question 4

What investigations should be performed when GORD is suspected?

Answer 4

Usually clinical Dx

24h oesophageal pH

Endoscopy with oesophageal biopsy

Question 5

How is GORD best managed?

Answer 5

Effortless regurgitation = no intervention, reassurance key

Breastfed + regurgitation = alginate (gaviscon) mixed with water post feed

Formula-fed + regurgitation =

1) ensure not over-fed (<150ml/kg/d total milk)
2) decrease feed vol by increasing frequency (2-3h)
3) feed-thickener
4) stop thickener start gaviscon added to formula

If no improvement after alginate 2w = omeprazole/ranitidine

Surgery = Nissen fundoplication

Question 6

Name the possible complications from GORD

Answer 6

• Failure to thrive from severe vomiting
• Oesophagitis - haematemesis, discomfort on feeding, iron def anaemia
• Recurrent aspiration pneumonia
• Dystonic neck posturing
• Apparent life-threatening events (ALTE)