Neonatal gastro-oesophageal reflux and aspiration — 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 the neonate it is almost always physiologic and self-limiting. GORD is reserved for reflux that causes complications — failure to thrive, haematemesis, oesophagitis, recurrent aspiration, or distress. This infant is thriving on the 9th centile 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 if there were bilious or green vomiting, forceful or projectile vomiting, faltering growth, visible blood in the vomit or anaemia, persistent irritability or arching, or recurrent aspiration. 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]