GORD in a child Flashcards
What is the definition of GORD in a child?
Involuntary passage of gastric contents into the oesophagus
What is the epidemiology of GORD in a child?
Very common
Esp. in <1 y/o
What is the rough pathogenesis of GORD in a child?
Functional immaturity –> inappropriate relaxation of lower oesophageal sphincter
What are the risk factors for GORD in a child?
Predominantly fluid diet
Mainly horizontal posture
Short intra-abdominal oesophageal length
What are the features of GORD in a child?
Recurrent regurgitation and vomiting
Put on weight normally
Otherwise well
In which children is GORD worse?
W/ cerebral palsy/other neurodevelopmental disorders
Preterm babies
Post surgery for oesophageal atresia/diaphragmatic hernia
How is diagnosis of GORD in a child usually made?
Clinical
No other investigations needed
When are investigations into GORD in a child indicated?
Atypical history
Complications
Failure to respond to treatments
What are some investigations that can be done for GORD in a child?
24 oesophageal pH monitoring - to quantify the reflux
24 hour impedance monitoring
Endoscopy and oesophageal biopsies - to identify oesophagitis
What are the categories of management options of GORD in a child?
Uncomplicated
Significant
Surgical management
What is the management for uncomplicated GORD in a child?
Parental reassurance
Inert thickening agents (e.g. Nestargel, Carobel)
30 degrees head up prone positioning
What is the management for significant GORD in a child?
Acid suppression
Increased gastric emptying (poor evidence)
How does acid suppression work to treat GORD in a child?
Decreases volume of gastric contents and treat acid-related oesophagitis
What are medication options for acid suppression in the management of GORD in a child?
H2 receptor antagonists (e.g. ranitidine)
PPIs (e.g. omeprazole)
What is the surgical management of GORD in a child?
Nissen fundoplication - fundus is wrapped around intra-abdominal oesophagus
