GERD

Question 1

Definition

Answer 1

Abnormal retrograde of gastric contents into oesphagus due to persistent relaxation of lower oesphageal sphincter (LES) Incidence: - Mainly in neonates & young infants - 60% improve with age (resolve by 6 mo-2years).

Question 2

Clinical picture A. Uncomplicated cases

Answer 2

1. Vomiting

• At the end of the feed
• From the 1 st week of life
• Increase with lying flat
• May be bile stained.

2. Sandifer syndrome: abnormal head posture and opisthotonus to protect airways.
3. Substernal pain and dysphagia in older child 🧒

Question 3

Clinical manifestations Complicated cases

Answer 3

• Oesphagitis ➡️GIT bleeding
• Recurrent aspirations ➡️ recurrent aspiration pneumonia
• Chronic cough & chest wheezes
• Growth retardation
• May be sudden infant death syndrome(SIDS) due to laryngospasm and apnea

Question 4

Treatment Medical

Answer 4

• Feeding : Thickening feedings with rice or oat cereal (1tablespoon/ounce) „ Position
• Head up for 30 min after feeding. However, the “infant seat” may worsen reflux by increasing intraabdominal pressure
• Supine position reduces SIDS but worsen GERD
• When the infant is awake and observed, prone position and upright carried position can be used to minimize reflux.

„ Pharmacotherapy S Ameliorate acidity by:

Anti-acids Histamin-2 (H2) receptor blockers e.g. Ranitidine Proton pump inhibitors(PPIs) e.g. omeprazole, esomeprazole S Prokinetics: controversial and not recommended

Question 5

Tx Surgical

Answer 5

Operation

• Fundo plication Indications
• Failed medical treatment
• Complications. e.g. Growth retardation