3 - Paeds - Gastro - GORD Flashcards
very common when? due to what? increased risk by..3 things?
in infancy
inappropriate relaxation of lower oesophageal sphincter
predom fluid diet, mainly horizontal posture, short intra abdo length of oesophagus
usually prognosis of infant GORD? what recurring things do most GORD infants have?
usually resolves by 12m
most infants with GOR have recurrent regurg and vomiting but otherwise well and gaining weight
Sever reflux is common in… ? 3 pt groups
- cerebral palsy/neuro disorder kids
- preterm infants (esp if Bronchopulm Dysplasia)
- following surgery for oesophageal atresia or diaphragmatic hernia
how diagnosed? Ix?
clinical diagnosis
Ix only if abnormal Hx, complications, or failure to respond to trt
what Ix are done if needed?
- 24h oesophageal pH monitoring
- 24h impedance monitoring
- endoscopy with oesophageal biopsies
- contrast studies of upper GIT (r/o anatomy abnormalities eg malrotation)
MGMT of uncomplicated GOR
excellent prog
parental reassurance
add inert thickening agents to feeds
pos at 30 deg prone after feeds
MGMT of significant GOR
- acid suppression - H2RA (ranitidine) PPI (omeprazole)
- > reduce gastric acid and treat acid related oesophagitis
- enhance gastric emptying (domperidone)
If failure to respond to significant GOR mgmt?
consider other diagnosis -> CMPI, lactose intolerance, pyloric stenosis
What indicates surgical mgmt? what is done?
unresponsive to intensive medical trt or oesophageal stricture - Nissen fundoplication done open/lapro
General complications from GORD - 4 things
FTT from vomiting
Oesophagitis - haematemesis, heartburn, IDA
Recurrent pulm aspiration - pneumonia, cough/wheeze, apnoea in preterms
Dystonic neck posture - sandifer syndrome
What two other complications may occur?
Sudden Infant Death Syndrome
SIDS
Barrett’s oesophagus - rare in kids, metaplasia of lower oesophagus due to acid damage from squamous to columnar > cancer
