GORD Flashcards
(12 cards)
What is GORD?
Where contents from the stomach reflux through the LOS into the oesophagus, throat and mouth.
What is the pathophysiology of LOS in babies?
There’s immaturity of the LOS in babies, allowing stomach contents to easily reflux into the oesophagus. It’s normal for a baby to reflux feeds, and if there’s normal growth of the baby and they’re otherwise well, it’s not a problem.
What is the presentation of reflux in babies?
Normal for babies to have some reflux after larger feeds.
Problematic reflux includes chronic cough, hoarse cry, distress, crying or unsettled after feeding, reluctance to feed, pneumonia, and poor weight gain.
What symptoms may children over 1 year experience?
Similar symptoms to adults: heartburn, acid regurgitation, retrosternal or epigastric pain, bloating and nocturnal cough.
What are some causes of vomiting in children?
- overfeeding
- GORD
- pyloric stenosis (projectile vomiting)
- gastritis or gastroenteritis
- appendicitis
- infections eg. UTI, tonsilitis or meningitis
- intestinal obstruction
- bulimia
What are the red flags for vomiting in children?
- not keep down any feed (pyloric stenosis or intestinal obstruction)
- projectile or forceful vomiting (^)
- bile stained vomit (intestinal obstruction)
- haematemesis or malaena (peptic ulcer, oesophagitis or varices)
- abdominal distension (intestinal obstruction)
- reduced consciousness, bulging fontanelle or neurological signs (meningitis or raised ICP)
- respiratory symptoms (aspiration and infection)
- blood in the stools (GE or CMPA)
- signs of infection (pneumonia, UTI, tonsilitis, otitis, meningitis)
- rash, angioedema and other signs of allergy (CMPA)
- apnoeas = concerning feature and may indicate serious underlying pathology + needs urgent assessment
What is the management in simple cases?
Reassurance + practical advice, small frequent feeds, burping regularly to help milk settle, not overfeeding, keep the baby upright after feeding.
What is the management in problematic cases?
- gaviscon mixed with feeds
- thickened milk or formula (specific anti-reflux formulas)
- PPI eg. omeprazole where other methods are inadequate
What is the management in severe (but rare) cases?
Further investigation with barium meal and endoscopy, surgical fundoplication in very severe cases but very rare.
What is Sandifer’s syndrome?
- rare congenital condition causing brief episodes of abnormal movements associated with GORD in infants
- the infants are usually neurologically normal
What are the key features of Sandifer’s syndrome?
- torticollis: forceful contraction of the neck muscles causing twisting of the neck
- dystonia: abnormal muscle contractions causing twisting movements, arching of the back or unusual postures
What is the management for Sandifer’s syndrome?
It usually resolves as the reflux is treated/improves. Can refer these patients to specialist for assessment to rule out differential diagnosis of infantile spasms (West syndrome) and seizures.
