GORD

Question 1

How does reflux change with increased age?

Answer 1

c.40% of infants aged 3-4m spit up their feeds
<5% of infants aged 13-14m, spit up their feeds

90% of affected infants resolve before 1yr + most cases dont need further investigation

Question 2

How might GORD present in infants/children?

Answer 2

Regurgitation 
Feeding difficulties e.g. gagging/choking 
Distress
Chronic cough, wheeze, hoarseness 
Single episode of 
pneumonia 
Heartburn, epigastric pain 

Red flags:

• Projectile vomiting (pyloric stenosis)
• Bile stained vomit, distension/mass (obstruction)
• Haematemesis (bleed)
• Onset of regurgitation/vomiting after 6m or persisting after 1yr (e.g. UTI)
• Blood in stool (CMPA, bacterial entiritis, bleed)

Question 3

How do you investigate GORD in infants/children?

Answer 3

Not always indicated - usually only if red flags are present, if so, the urgent:

• Upper GI contrast
• Endoscopy
• pH studies

Question 4

How do you manage GORD in infants/children?

Answer 4

Feeding:

• upright position
• review frequency (smaller + more frequent)
• review volumes
• change feeds e.g. thicker

Drugs: (NOT IF ISOLATED SYMPTOM)

• PPI - omeprazole (4wk trial)
• H2 receptor blockers - ranitidine (4wk trial)
• Antacids - magnesium or calcium carbonate, sodium bicarbonate

Question 5

What are some complications of untreated GORD?

Answer 5

Faltering growth, failure to thrive

Oesophagitis +/- stricture

Apnoeas (possible sudden infant death syndrome…)

Aspiration

Iron deficiency anaemia

Frequent otitis media

Question 6

What are some risks associated with increased prevalence of GORD?

Answer 6

Prematurity
FHx
Obesity
Hiatus hernia
Congenital diaphragmatic hernia (repaired)
Congential oesophageal atresia (repaired)
A neurodisability