GORD

Question 1

What is Gastro-oesophageal Reflux (GOR)?

Answer 1

• The passage of gastric contents into the oesophagus

Question 2

What is Gastro-oesophageal Reflux Disease (GORD)?

Answer 2

• The reflux causes symptoms or complications

Question 3

What is Regurgitation?

Answer 3

• The reflux of stomach contents beyond the oesophagus

Question 4

What is the Pathophysiology of GORD?

Answer 4

• The lower oesophageal sphincter along with the diaphragm is responsible for preventing stomach contents from entering the oesophagus.
• In cases of GORD the tone of the muscular portion of the lower oesophagus is too low causing uncontrolled refluxing of the stomach contents

Question 5

What features are present in infants which can predispose to GORD?

Answer 5

• Short, narrow oesophagus
• Delayed gastric emptying
• Shorter, lower oesophageal sphincter above the diaphragm
• Liquid diet and high calorie requirement - distending the stomach

Question 6

What are the Risk Factors for GORD?

Answer 6

• Prematurity
• Obesity
• Hiatus Hernia
• Family history of heartburn

Question 7

What questions would you ask to help distinguish you from GOR and GORD?

Answer 7

• Any distressed behaviour (excessive crying, unusual neck postures, back-arching)
• Unexplained Feeding Difficulties (refusing feeds, gagging, choking)
• Hoarseness of voice
• Chronic cough
• Episodes of Pneumonia
• Faltering growth
• relationship of symptoms to feeds

Question 8

What would you look for on examination for GORD?

Answer 8

• Hydration status
• Signs of Malnutrition
• Faltering Growth

Question 9

What are the Differential Diagnosis of GORD?

Answer 9

• pyloric stenosis
• intestinal obstruction - malrotation volvulus
• Sepsis
• Haematemesis
• Acute surgical abdominal issue

Question 10

What is the managment for GORD if breast fed?

Answer 10

• If breast-fed with frequent regurgitation use and alginate (Gaviscon) mixed with water immediately after feeds.

Question 11

What is the management for GORD if formula fed?

Answer 11

1. Ensure the infant is not over fed
2. Decrease feed volume by increasing frequency (2-3 hours)
3. Use feed-thickener
4. Stop thickener and start alginate

Question 12

What do you do if there is no improvement with alginate therapy?

Answer 12

• After 2 weeks Start PPI or Histamine Antagonist
• If symptoms persist refer to paediatrics

Question 13

What are the complications of GORD?

Answer 13

-Reflux oesophagitis
- Aspiration Pneumonia
- Recurrent acute otitis media

Question 14

What is the prognosis of GORD?

Answer 14

• Most spontaneously resolve within the first year - as they grow older, have a more of a solid diet and spend more time upright