Gastroesophageal reflux disease

Pre-referral guidelines for primary care providers

Gastroesophageal reflux (GOR) is the very common process of regurgitating stomach contents into the oesophagus, often manifest as vomiting in infants. Up to two thirds of all healthy infants will have some degree of GOR.

Gastroesophgeal reflux disease (GORD), which is much less common, is when GOR leads to medical complications such as failure to thrive, aspiration or oesophagitis.

For the management of GOR and GORD, please refer to the Royal Children’s Hospital clinical practice guidelines.

For vomiting outside the infant age group, please see the vomiting pre-referral guideline.

Practice points

  • Gastroesophageal reflux (GOR) is very common in normal healthy infants, often with associated vomiting, and requires no active management.
  • GOR is common in irritable infants, although is not necessarily the cause
    • Studies have not shown an association between irritability episodes and GOR in those babies who vomit less than 4 times per day.
  • There is no role in changing formulas in the management of GOR (unless associated with a cow's milk protein intolerance)
  • The use of positioning techniques and thickeners has been shown to be helpful in the management of GORD.
  • The use of acid suppressing medications, although sometimes useful to reduce symptoms of true GORD, have not been shown in randomised controlled trials to be better than placebo at reducing irritability or vomiting associated with GORD.

Referral pathways

  • Paediatrician
    • The vast majority of infants with GOR do not require paediatrician input and can be safely managed in the general practice environment.
    • Referral to paediatric outpatient services is reasonable when there is GORD associated with failure to thrive, oesophagitis or aspiration, other features of atopy (including mod-severe eczema), or if the vomiting is persistent beyond 18 months.