Clinical features

Features are as follows:

• regurgitation or persistent vomiting - generally posseting
  • the vomiting usually occurs after a feed when a small amount of food is regurgitated. From then until the next feed regurgitation may continue.
  • at times the vomiting may forceful and may even be projectile.
  • the vomit is never bile-stained but may contain frank or altered blood or mucus. Bile stained vomit implies a surgical cause - particularly volvulus - until proven otherwise.
• feeding refusal
• back arching/irritability/persistent crying (1)
• poor weight gain and failure to thrive - most infants with this condition thrive normally and are not distressed by this condition, although in some infants the vomiting may be severe enough to restrict growth (2)
• oesophageal symptoms - haematemesis, dysphagia, odynophagia - may occur in severe disease
• anaemia - may occur in severe disease
• respiratory symptoms may be present in severe disease - wheezing, stridor, cough, hoarseness, apnoea spells with cyanotic episodes (apparent life-threatening events) (2,3)
• there may be aspiration of milk so that the presentation will be that of cough and wheezing
• dental erosion (3)
• abnormal hyperextension of the neck with torticollis - Sandifer's syndrome
• sleeping difficulties (1)

All infant with GORD will not present with visible regurgitation (“silent” GORD) (2)

Reference:

• (1) Saedon M, Gourgiotis S, Germanos S. Is there a changing trend in surgical management of gastroesophageal reflux disease in children? World J Gastroenterol. 2007 Sep 7;13(33):4417-22
• (2) Jung A.D. Gastroesophageal Reflux in Infants and Children. Am Fam Physician. 2001;64(11):1853-60
• (3) Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). Journal of Pediatric Gastroenterology and Nutrition 2009; 49:498–547