Pediatric Gastroenterology Management and Referral Guidelines for GERD, Slides of Gastroenterology

Download Pediatric Gastroenterology Management and Referral Guidelines for GERD and more Slides Gastroenterology in PDF only on Docsity!

Management and Referral Guidelines

Pediatric Gastroenterology

Management and Referral Guidelines

Provided by

Management and Referral Guidelines

Gastro-Esophageal Reflux Disease (GERD) (K21)

Diagnosis : ICD-

Gastro-esophageal reflux disease with esophagitis: K21.

Gastro-esophageal reflux disease without esophagitis: K21.

Newborn esophageal reflux: P78.

Target Population

• Infants
• Children
• Young adults up to 21 years of age

Clinical Findings

Appropriate distinction between gastroesophageal reflux and true gastroesophageal reflux disease is vital to initiating proper treatment.

• Gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus with or without regurgitation and vomiting. Most episodes of reflux in healthy individuals last less than 3 minutes, occur in the postprandial period, and cause few or no symptoms. Sometimes infants (0 to 12 months) spit up but do not have symptomatic reflux. About 50% of healthy 3- to 4-month-old infants spit up at least once a day. This is known as “happy spitting.” Most infants with asymptomatic GER grow normally and the condition often peaks at 4 months and resolves by 12 to 18 months of age.
• In contrast, gastroesophageal reflux disease (GERD) is present when the reflux of gastric contents causes troublesome symptoms and/or complications (e.g., retarded weight gain, pneumonia, vomiting blood, or other related problems)

Evaluation Recommendations

• In the event of forceful or bilious vomiting , consider pyloric ultrasound for infants and UGI for older age group.
• In the event of GI bleeding , refer to GI or admit based on severity of the bleeding
• In the event of weight loss and feeding refusal , consider admission to the hospital for observation and work up

Red Flags

• Vomiting associated with o Blood (e.ge, bright red streaks, blood clots of coffee ground appearance in stomach fluids o Green or yellow fluid
• Arching away from breast/bottle with crying or irritability
• Persistent crying
• Feeding difficulties (e.g., choking or gagging with feeds) and feeding refusal
• Poor growth or failure to thrive

Management and Referral Guidelines

response is satisfactory.

Continue PPI for 3 months.

Referral If treatment fails, refer to Pediatric

Gastroenterology or try PPI

If the child is not improving in

1-2 weeks or if unable to wean

off the medication after three

months, refer to GI

These guidelines are designed to be used by primary care physicians wishing to refer children

with suspected gastroesophageal reflux disease for additional evaluation and care. They are

recommendations and are based on best evidence and expert consensus.

If at any time patient develops signs/symptoms that make more urgent evaluation important, please alert Gastroenterology (512-628-1810) to this change in status.