Reflux and GORD

Question 1

GORD

Maturation aspects

Answer 1

Physiological reflux
Oesophagus clearance mechanisms
Majority resolve by 1-4yo

Question 2

Antireflux mechanisms

Answer 2

Extrinsic (crura, angle of His)

Intrinsic (LOS, increased tone)

Question 3

Reflux predisposition

Answer 3

CP
Tubes in seriously ill pt
Sliding hiatus hernia

Question 4

Reflux clinical presentation

Respiratory symptoms

Answer 4

Recurrent pneumonia
Persistent cough
Wheezing
Reactive airways
Apnoea attacks
Stridor
Sandifer syndrome

Question 5

Reflux clinical presentation

Failure to thrive

Answer 5

Calorie loss

Question 6

Reflux clinical presentation

Complications

Answer 6

Oesophagitis, bleeding and anemia
Dysphagia
Stricture formation

Question 7

GORD investigations

Answer 7

Contrast study: barium swallow
Oesophageal pH monitoring
Oesophageal impedance monitoring
Radionucleotide scintigraphy, “milk scan”
Endoscopy

Question 8

Barium swallow in reflux investigations

Answer 8

Anatomical issues eg pyloric stenosis, malrotation, hiatal hernia, stricture
NOT specific or sensitive to GORD

Question 9

pH metry in reflux investigations

Answer 9

Gold standard

but higher cost and required expertise

Question 10

Milk scan in reflux investigations

Answer 10

4 part study (oesophageal transit, reflux, gastric emptying, pulmonary aspiration)

Question 11

Endoscopy in reflux investigations

Answer 11

Visualise oesophagitis

Biopsy (Barret’s oesophagitis, CMV, candida, H pylori)

Question 12

GORD management

Answer 12

Feeding and post-feeding position: prone, elevate

Change feeding pattern: frequent small feeds, thicken feeds: nestargel/ gelatine

H2 receptor antagonists, proton pump inhibitors: antacid: reduce acid, heal oesophagitis

Prokinetic agents: cisapride (off the market), domperidone or metoclopramide before meals, erythromycin

Surgery: Nissen fundoplication