Gastroesophageal Reflux

Gastroesophageal Reflux (GOR) is a condition where the food contents from the stomach go back up to the oesophagus. It is very common in infants. It is estimated up to 50% of infants less than 3 months of age have reflux. Only 1% of these infants will still be experiencing reflux by the age of one.

 

Gastroesophageal reflux can presents in many ways such as regurgitation, distressed behaviour or irritability, back arching, disturbed feeding, recurrent cough, faltering growth and apnoea.

 

 

 

There are many ways to diagnose gastroesophageal reflux. A good detailed history is important. Barium swallow and abdominal ultrasound can detect reflux in real time. 24 hour pH study can detect acid reflux. New study pH impedance study can detect acid, non-acid and alkaline reflux. Gastroscopy helps to detect oesophagitis and oesophageal stricture (narrowing).

 

A simple non-complicating reflux need not require medicinal treatment. Reassurance and practical advice such as frequent winding, avoidance of over feeding, 30 degree head elevation, frequent smaller feeds are often suffice. Feed thickeners such as carobel, SMA Stay Down, Cow and Gate Anti-Reflux and Aptamil Anti-Reflux milk can be trialed before considering gaviscon. For infants whose reflux are not controlled with the above measures, antihistamine H2 receptor antagonist and proton pump inhibitors may be considered.

 

Food protein hypersensitivity (milk, soya, egg, wheat) can also cause reflux and should be considered if there is no relief from antihistamine H2 receptor antagonist or proton pump inhibitors. In these cases, reflux symptoms will improve only after eliminating these foods from their diet.