K21
DESCRIPTION
Gastro-oesophageal reflux is repetitive regurgitation/reflux of gastric contents into the oesophagus.
It is termed “Complicated GOR” or “GORD” if associated with the diagnostic criteria below.
It should be differentiated from “Uncomplicated GOR” if the only symptom is frequent small vomits, in which case no further investigation or treatment is needed and other causes of vomiting. Parents should be reassured that regurgitation improves spontaneously during the first year of life.
DIAGNOSTIC CRITERIA
- GORD should be suspected if: Recurrent vomiting or regurgitation and any of the following:
- respiratory symptoms, i.e. recurrent wheeze or cough, chronic obstructive airway disease, recurrent aspiration/pneumonia, stridor, apnoea and apparent life-threatening event;
- faltering of growth; and
- abnormal posturing or opisthotonus (Sandifer syndrome).
Consider other causes of vomiting and faltering of growth, such a pyloric stenosis, cow's milk allergy.
Investigations
Note: Routine investigations are seldom indicated. Discuss with specialist prior to performing investigations.
GENERAL AND SUPPORTIVE MEASURES
- Postural treatment: lying on the left side is currently recommended.
- Dietary measures such as feed thickeners. If not breastfeeding, frequent small volume feeds or specialised anti-reflux infant formula.
MEDICINE TREATMENT
Note: Evidence in support of the following recommendations is weak:
Specialist initiated:
- Omeprazole, oral, 0.7-1.4 mg/kg/day once daily, on an empty stomach for 4 weeks, then stop therapy. If symptoms reoccur and persist for 3-4 days after stopping, consider reinitiating.
- Maximum dose: 20–40 mg/dose.
If 1 month–2 years: 5 mg once daily
If > 2–6 years: 10 mg once daily
If > 7–12 years: 20 mg once daily
REFERRAL
- For diagnostic investigations, if not available locally.
- GORD not responding to treatment.