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Published byRonaldo Peplow Modified over 9 years ago
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Gastroesophageal reflux Definition: Retrograde flow from stomach into oesophagus Does not have to present at mouth
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Maturation aspects Oesophagus clearance mechanisms "Physiological reflux" Most resolve spontaneously by 1 - 4 yrs
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Iatrogenic causes of reflux Gavage feeding and tubes
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Problematic reflux incidence 1 in 300 to 1000 children 90% before 6 weeks age Untreated, 10% complications
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Predisposition Cerebral palsy Tubes in seriously ill patients
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Defective LES Motility Abnormal neural control of LES Transient Lower Oes. Sphinct. relaxation GER Oesophagitis Gastric distension Hiatus Hernia
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Mode of presentation I Simple regurgitation, thriving Vast majority No treatment Regurgitation with failure to thrive Loss of nutrients
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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
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Diagnosis Think of it Upper GI barium series Intra-oesophagus pH monitoring Radio-nuclear scintigraphy "milk scan“ Oesophagoscopy Biopsy
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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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