GERD

Question 1

What is the difference between GOR and GORD in paediatrics?

Answer 1

GOR - immaturity of the lower oesophageal sphincter, common in under 1yrs (40%). Not a concern

GORD - rarer, causes pain and complication

Question 2

What is the relevant aetiology of GORD?

Answer 2

1. Short oesophagus and weak oesophageal sphincter
2. Oesophageal sphincter above the diaphragm
3. Gastric distention due to liquid diet and high energy needs
4. Supine position

Question 3

What are the risk factors for GORD?

Answer 3

Preterm birth
Parental GORD
Obesity
Structural abnormalities - hiatus hernia, repaired oesophageal atresia, diaphragmatic hernia
Cerebral palsy

Question 4

What are the clinical features of GORD in neonates?

Answer 4

Chronic cough
Hoarse cry
Distress, crying or unsettled after feeding
Relucatnce to feed
Pneumonia
Poor weight gain
Vomiting

Question 5

What are the signs/symptoms of GORD for children?

Answer 5

Heartburn
Acid regurgitation
Epigastric/chest pain
Bloating
Nocturnal cough

Question 6

What children require same day referal for GORD?

Answer 6

1. Haematemesis, melaena or dysphagia
2. Diagnosis is uncertain or ref flag features
3. Not responding to first-line treatments
4. Associated complications - iron deficiency, anaemia, apnoea, seizures, recurrent associated infections

Question 7

What further investigations may need to be done for paediatrics with GORD?

Answer 7

1. pH impedance study - NG tube with a probe to monitor pH over 24hrs
2. Upper GI contrast study - hiatus hernia or achalasia
3. Gastroscopy - oesophagitis
4. Oesophageal manometry - motility and pressure

Question 8

What are the first management for paediatric GORD?

Answer 8

Small, frequent meals
Burping regularly to help milk settle
Not over-feeding
Keey baby upright after feeding

Question 9

What second line management can be used for GORD in paediatrics?

Answer 9

Gaviscon mixed with feeds
Thickened milk or formula
PPIs - omeprazole

Question 10

What is the prognosis of GOR in newborn?

Answer 10

Tends to resolve with good prognosis
Combination of growth, increased oesophageal tone, increased solids and reduced time spent lying down.