Gastro-oesophageal reflux and reflux disease — structured oral (viva)

Branch 1 — Definition and classification

Examiner: "Is this reflux or GORD, and what separates the two?" Candidate: This is physiologic gastro-oesophageal reflux. GOR is the effortless retrograde passage of gastric contents into the oesophagus, and in infants it is a normal, self-limiting developmental phenomenon. GORD is reserved for reflux that causes troublesome symptoms or complications — faltering growth, oesophagitis, haematemesis, recurrent aspiration, or distress impairing quality of life. This infant is thriving with effortless posseting and no red flags, so this is physiologic reflux, not disease. ^[1]

Examiner: "What red flags would change your mind?" Candidate: I would reconsider with bilious or green vomiting, forceful or projectile vomiting, faltering growth, haematemesis or anaemia, or recurrent aspiration. Late onset after six months or persistence beyond the first birthday would also make me look for another diagnosis. Bilious vomiting is the cardinal danger sign — it signals intestinal obstruction, most dangerously malrotation with volvulus, and it needs urgent contrast imaging and surgical review, not anti-reflux therapy. ^[1]