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Guidance issued by NICE on diagnosing serious reflux in the young

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The National Institute for Health and Care Excellence has published guidance on treating gastro-oesophageal reflux disease (GORD) in infants, children and young people more effectively.

NICE said the guidance was intended to help health professionals differentiate between normal episodes of reflux and those that were more serious and required treatment.  

“Healthcare professionals should reassure families but also take all concerns seriously”

Mark Baker

The term GORD refers to gastro-oesophageal reflux (GOR), which is so severe that medical treatment is required. It can happen for different reasons, but is most commonly caused by the lower oesophageal sphincter failing to work properly.

NICE noted that reflux – characterised by visibly regurgitating food after eating – was normal and affected 40% of infants, but could happen to almost everyone at some point in their lives.

It added that GOR usually becomes less frequent with time and symptoms usually disappeared in 90% of affected infants before they are one year old.

Professor Mark Baker, director of NICE’s clinical practice centre, said: “It can be difficult to differentiate between ‘normal’ episodes of reflux and more serious GORD, but this new NICE guideline will support medical professionals to make the correct diagnosis.

“It will mean infants, children and young people get the care that they need while also avoiding over-treating healthy children,” he said.

Health professionals should support and advise families on the difference between GOR and GORD, according to the new guidance.

A child’s symptoms should be reviewed if regurgitation becomes persistently projectile or vomit is bile stained – green or yellow-green – or has blood in it.

New concerns, such as feeding difficulties, faltering growth or marked distress, or where regurgitation is persistent and frequent beyond the child’s first year of life should also spark a diagnosis review, said the institute.

Professor Baker added: “GOR and GORD in infants, children and young people, although common, can be very distressing.

“Healthcare professionals should reassure families but also take all concerns seriously,” he said. “GORD can be treated well with medication, so specialist referrals should be given to those children whose symptoms persist.”

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