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Published on: January 17, 2011
Gastro-oesophageal reflux disease in infancy: a review based on international guidelines
Robert N Lopez1, Daniel A Lemberg2
1Queensland Children's Hospital, Brisbane, QLD.
Insights
Gastro-oesophageal reflux disease (GORD) in infants is diagnosed clinically, often requiring careful evaluation to distinguish it from common reflux. Management prioritizes non-pharmacological approaches before considering medication.
Area of Science:
- Pediatrics
- Gastroenterology
Background:
- Gastro-oesophageal reflux (GOR) is common and physiological in infants.
- Gastro-oesophageal reflux disease (GORD) involves complications or significant symptoms.
- GORD is more prevalent in infants with comorbidities like prematurity or neurological impairment.
Purpose of the Study:
- To differentiate GOR from GORD in infants.
- To outline diagnostic approaches for infant GORD.
- To guide management strategies for infant GORD.
Main Methods:
- Diagnosis relies primarily on clinical history and physical examination.
- Invasive testing and empirical therapy roles are not clearly defined.
- Assessment focuses on identifying red flags and excluding other pathologies.
Main Results:
- Clinical evaluation is the cornerstone of GORD diagnosis in infants.
- Investigations are used selectively to rule out other conditions or confirm GORD.
- A step-wise management approach is recommended.
Conclusions:
- Distinguishing GOR from GORD requires careful clinical assessment.
- Non-pharmacological interventions should be prioritized in GORD management.
- Pharmacological treatments are reserved for necessary cases.
Abstract:
Gastro-oesophageal reflux (GOR) in infancy is common, physiological and self-limiting; it is distinguished from gastro-oesophageal reflux disease (GORD) by the presence of organic complications and/or troublesome symptomatology. GORD is more common in infants with certain comorbidities, including history of prematurity, neurological impairment, repaired oesophageal atresia, repaired diaphragmatic hernia, and cystic fibrosis. The diagnosis of GORD in infants relies almost exclusively on clinical history and examination findings; the role of invasive testing and empirical trials of therapy remains unclear. The assessment of infants with vomiting and regurgitation should seek out red flags and not be attributed to GOR or GORD without considered evaluation. Investigations should be considered to exclude other pathology in infants referred with suspected GORD, and occasionally to confirm the diagnosis. Management of GORD should follow a step-wise approach that uses non-pharmacological options where possible and pharmacological interventions only where necessary.
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