Neonatal gastro-oesophageal reflux and aspiration — 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. In neonates it is almost always physiologic. GORD is reflux that causes complications — failure to thrive, haematemesis, oesophagitis, recurrent aspiration, or distress — and the distinction rests entirely on the presence of these complications. ^[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 and metabolic mimic include bilious or green vomiting, forceful or projectile vomiting, failure to thrive, visible blood in the vomit or anaemia, persistent irritability or arching suggestive of pain, and recurrent respiratory events indicating aspiration. ^[1]

Bilious vomiting is the cardinal danger sign because it signals intestinal obstruction, most dangerously malrotation with volvulus, and it demands urgent contrast imaging and surgical review rather than anti-reflux therapy. ^[1]