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Gastroesophageal reflux Definition: Retrograde flow from stomach into oesophagus Does not have to present at mouth.

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Presentation on theme: "Gastroesophageal reflux Definition: Retrograde flow from stomach into oesophagus Does not have to present at mouth."— Presentation transcript:

1 Gastroesophageal reflux Definition: Retrograde flow from stomach into oesophagus Does not have to present at mouth

2 Maturation aspects Oesophagus clearance mechanisms "Physiological reflux" Most resolve spontaneously by yrs

3 Iatrogenic causes of reflux Gavage feeding and tubes

4 Problematic reflux incidence 1 in 300 to 1000 children 90% before 6 weeks age Untreated, 10% complications

5 Predisposition Cerebral palsy Tubes in seriously ill patients

6 Defective LES Motility Abnormal neural control of LES Transient Lower Oes. Sphinct. relaxation GER Oesophagitis Gastric distension Hiatus Hernia

7 Mode of presentation I Simple regurgitation, thriving Vast majority No treatment Regurgitation with failure to thrive Loss of nutrients

8 Mode of presentation II Regurgitation with respiratory symptoms Recurrent pneumonia Persistent cough Wheezing Aspiration Vagus mediated Apnoea attacks Regurgitation with complication Anaemia from blood loss Stricture formation

9 Diagnosis Think of it Upper GI barium series Intra-oesophagus pH monitoring Radio-nuclear scintigraphy "milk scan“ Oesophagoscopy Biopsy

10 Management Feeding and post-feeding position : prone, elevate Change feeding pattern : frequent small feeds, thicken feeds : Nestargel/ gelatine H2 receptor antagonists, proton pump inhibitors : antacid : reduce acid, heal oesophagitis Prokinetic agents: cisapride (off the market), domperidone or metoclopramide before meals Surgery


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