Gastro-oesophageal reflux and reflux disease — short-answer question

Part A — Diagnosis and classification (10 marks)

a) Define gastro-oesophageal reflux and distinguish it from GORD (4 marks)

Gastro-oesophageal reflux is the effortless retrograde passage of gastric contents into the oesophagus, with or without regurgitation, and in infants it is a normal physiologic phenomenon. GORD is reflux that causes troublesome symptoms or complications — faltering growth, oesophagitis, haematemesis, recurrent aspiration, or distress that impairs quality of life — and the distinction rests entirely on the presence of these features rather than on the reflux itself. ^[1]

b) List the red flags that indicate this is NOT simple physiologic reflux (6 marks)

The red flags that shift the picture from physiologic reflux to GORD or to a surgical, allergic, or systemic mimic include bilious or green vomiting, forceful or projectile vomiting, faltering growth, haematemesis or occult blood with anaemia, and recurrent respiratory events suggesting aspiration. Onset after six months of age or persistence beyond the first birthday is itself atypical and should prompt a search for another cause. ^[1]

Bilious vomiting is the cardinal danger sign because it signals intestinal obstruction, most dangerously malrotation with volvulus, and it demands urgent upper gastrointestinal contrast imaging and surgical review rather than anti-reflux therapy. This infant has none of these features, so this is physiologic reflux. ^[1]