Excerpt

This guideline focuses on symptoms of and interventions for gastro-oesophageal reflux disease (GORD). Commonly observed events, such as infant regurgitation, are covered, as well as much rarer but potentially more serious problems, such as apnoea. Where appropriate, clear recommendations are given as to when and how reassurance should be offered. In contrast, advice is given to health care professionals regarding when investigations should be considered or treatments are indicated. Finally, it is emphasised that other, and on occasion more serious, conditions that need different management can be confused with some of the relatively common manifestations of GOR or GORD. These warning signs are defined under the headings of ‘red flags’, along with recommended initial actions.

The focus of this guideline is primary and secondary care while ‘dove-tailing’ with the likely investigation and management that could be expected when a referral to tertiary care is indicated. Where a particular area of specialist interest is not covered as expected, this is likely to be because of the very specific focus of the guideline or due to a lack of evidence or consensus. This guideline is specifically about GORD in children. It is not a detailed guideline on complex feeding issues, a protocol for an approach to ‘the vomiting child’ or a textbook for the tertiary specialist. In addition, where there is a perceived absence of evidence or a lack of consensus then other specific areas may appear neglected, but when this occurs an effort has been made to make detailed and prescriptive research recommendations.

Contents

• Guideline summary
• 1. Introduction
  • 1.1. Aim of the guideline
  • 1.2. Definitions used in this guideline
  • 1.3. Areas within the remit of the guideline
  • 1.4. Areas outside the remit of the guideline
  • 1.5. For whom is this guideline intended
  • 1.6. Who has developed the guideline
  • 1.7. Related NICE guidelines
• 2. Guideline development methodology
  • 2.1. Developing review questions and protocols and identifying evidence
  • 2.2. Reviewing and synthesising evidence
  • 2.3. Outcome measures
  • 2.4. Incorporating health economics
  • 2.5. Evidence to recommendations
  • 2.6. Stakeholder involvement
• 3. Recommendations and care pathway
  • 3.1. Key priorities for implementation
  • 3.2. Recommendations
  • 3.3. Research recommendations
  • 3.4. Care pathway
• 4. Diagnosing and investigating GORD
  • 4.1. Natural course of overt regurgitation
  • 4.2. Signs and symptoms
  • 4.3. Risk factors
  • 4.4. Indications for investigation and treatment
• 5. Initial management of GOR and GORD
  • 5.1. Infant positioning
  • 5.2. Feeding changes
  • 5.3. Aliginates and antacids
• 6. Pharmacological treatment of GORD
  • 6.1. H₂ receptor antagonists, proton pump inhibitors and prokinetics
• 7. Enteral tube feeding for GORD
  • 7.1. Intra-gastric and intra-jejunal tube feeding
• 8. Surgery for GORD
  • 8.1. Fundoplication
• 9. Glossary and abbreviations
• References
• Appendices
  • Appendix A. Health economics
  • Appendix B. Scope
  • Appendix C. Stakeholders
  • Appendix D. Declarations of interest
  • Appendix E. Review protocols
  • Appendix F. Search strategies
  • Appendix G. Summary of identified studies
  • Appendix H. Excluded studies
  • Appendix I. Evidence tables
  • Appendix J. Parent information on administration of medicines

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.