Investigations

BARIUM SWALLOW

The baby/child is given a white strawberry flavoured liquid to swallow. For babies this will be administered from a bottle, or through a nasal gastric tube if necessary. An X-ray is taken by a Radiologist (X-ray Doctor), which is projected on a video screen, and then analysed.

This investigation is positive in approximately 50 to 60 percent of babies/children who clinically suggest GOR (gastro-oesophageal Reflux). The examination may demonstrate reflux, the wave pattern in the oesophagus, and the rate of emptying of the stomach. Importantly, this investigation shows whether the anatomy of the oesophagus and stomach are normal and if the baby/child has a hiatus hernia.

Babies/children with GOR may not reflux during the period of the screening, producing a normal reading. A Barium Swallow is therefore not a very reliable test for reflux, as it is possible for a baby/child to have reflux but it not to be picked up by this investigation.

It is common for the Barium preparation to cause constipation, and it should not be left to harden in the bowel. Therefore a laxative may need to be used if constipation is, or becomes a problem. It is useful to take the baby/child’s favourite bottle or cup to administer the barium preparation, as this may make the procedure more acceptable to them.


GASTROSCOPY/ENDOSCOPY

This investigation involves 15 minutes under a general anaesthetic if the symptoms and signs suggest reflux oesophagitis. The endoscopist (the doctor who performs the endoscopy) is able to assess the degree of oesophagitis (inflammation in the oesophagus), and whether there are any problems in the stomach and duodenum. A biopsy (specimen of the oesophageal lining) may be taken for pathological examination.

Other conditions such as coeliac disease (gluten intolerance), food allergies, lactose and other sugar intolerances, helicobactor pylori etc. can also be diagnosed from appropriate biopsies taken during an endoscopy.

This investigation is also a very important step before surgery is considered.


pH PROBE

A probe sensitive to pH changes (thus an index of acidity) is positioned in the oesophagus. This investigation demonstrates the presence, frequency and duration of reflux episodes. For accuracy of result, the probe is left in the oesophagus for 18 – 24 hours, and an X-ray needs to be taken once the probe is in place to confirm it is positioned accurately.

This is a good test for determining whether a baby/child has reflux or not, and the severity of the condition. Several types of readings are taken, but the most crucial one is the % of reflux over 24 hours. In general: – under 5% is normal, 5 – 10% is mild, 10 – 20% is moderate and over 20% is severe. However, the severity of the condition is no indication of treatment needed e.g. a baby/child with mild reflux may still need Omeprazole, whereas a baby/child with severe reflux may remain well controlled on Zantac.


OTHER

Diagnosing GER in Children – http://www.medscape.com/viewarticle/742615?src=mp&spon=9“The measurement of pH is the predominant modality used to diagnose gastroesophageal reflux (GER) in children. However, pH monitoring provides only part of the answer with respect to whether a child has reflux episodes. Multichannel intraluminal impedance monitoring can measure acidic and nonacidic reflux episodes using pressure-sensing electrodes along the length of the probe.” I haven’t heard of impedance monitoring being used in New Zealand.

© Gastric Reflux Association for the Support of Parents/babies (GRASP) and Crying Over Spilt Milk Gastric Reflux Support Network New Zealand for Parents of Infants and Children Charitable Trust (GRSNNZ) 2004. Used, edited and added to by GRSNNZ with permission.

Page may be printed or reproduced for personal use of families, as long as copyright and Crying Over Spilt Milk‘s URL are included. It may not be copied to other websites or publications without permission and acknowledgement. This information (unedited) was also provided (by GRASP) to health professionals in New Zealand to use ” to continue to support and inform families with babies/children with Gastro-oesophageal Reflux.”

  • http://www.cryingoverspiltmilk.co.nz/new-baby-on-the-way-taking-probiotics/ - New story from one of our Kiwi Health, Pregnancy and Parenting Forum users. Nice to have positive stories.

    Well I thought I would update you all on our baby. She was born on 24th August, the day before her due date and on my birthday. I was taking 3 x 2 caps of Probiotics per day in the last month of pregnancy which can seem excessive, but as I can’t overdose on them and I only get one chance...

  • Are there any breastfeeding Mums out there? My little girl is about to turn 7mths and has finally been diagnosed with silent reflux (alot of people dismissed me when I suggested it months ago). We have started on Gaviscon sachets nearly 48hrs ago and she is much better especially at settling in the evening. She is usually OK at night so haven't given her the powder when she wakes at night yet. Any tips on how to use at night? I have been mixing it up and syringing it into her mouth. Packet says not to make up in advance but I wondered if I could for nighttime so I don't have to make it up when she wakes. Thanks

  • Anyone else dealing with older children with reflux would love to hear from you my Miss 11 year old seems to be having a relapse . So after nearly 4 years losec free in this household we have it back.

  • There have been some new posts - sorry I haven't had a chance to pop on over and answer. Can anyone share their experiences? Remember, no medical advice. :-)

  • As per my post yesterday, our membership form and newsletter archive for members is now available again. Please consider joining Gastric Reflux Support Network NZ for Parents of Infants and Children Charitable Trust for access to our Newsletters and Private Local and National Support Networks: http://www.reflux.cryingoverspiltmilk.co.nz/grsnnz-membership-confidentiality-agreement-form/ Membership is free, and this gives you opportunities to discuss gastric reflux related issues with others in a safe and confidential setting. Thanks to one of our amazing webhosts http://www.webmad.co.nz/ for the smooth change-over.

    Gastric Reflux Support Network NZ for Parents of Infants & Children Charitable Trust Membership & Confidentiality Agreement Form / Newsletter Admin Page First Name Last name Email Street Address City/Town Area Postcode Do you live in NZ? Country and Area if not NZ Home Phone (include area code) Part…

  • The website our membership form is on and where are newsletters are archived is down for maintenance until late tomorrow evening - Monday at the latest. If you were wanting to complete a membership form, please do check back as we would love to meet you. I'll post an update when it is available again. www.cryingoverspiltmilk.co.nz is available as usual although it the server it is on is changing tomorrow evening also - hopefully there will be no disruption.

    For infant and child gastric reflux support in New Zealand: Phone/Text 022 585 5935 Phone 0800 380 517 Contact GRSNNZ via email form GRSNNZ has brochures available which explain what Gastric Reflux is, a few simple tricks, the support GRSNNZ offers and our contact details. If you are Health...

  • A question please -my daughter has twin girls aged 3 weeks.They were premature born at 35 weeks 3 days.One of them is fine breastfed and sleep.However the other one grunts and groans,pulls her legs up and sometimes cries after each feed.She does not settle well at all.Could this be reflux or what.I know it's early days but my daughter is exhausted!!Any suggestions would be great.Thanks

  • I have a question for mothers who have tried feed thickner. Can constipation occur when using this? I have checked the karicare website but does not state any side effects.

  • I have removed the recent video to our page on how to give Losec mups that was shared by someone. These are not available in NZ.

  • Hi there, I just want to say how helpful your website is, it is jam packed full of useful info! Thank you for being here!!!!!

  • Wahoo, Ben Ataya

  • 2500 lol

  • My 10 week old son is in starship due to heart condition. His omeprizol has just been doubled to try and ease his discomfort with reflux. He is now on twice daily but a nurse said she had heard it was more effective given as a single dose? What are the advantages and disadvantages of a single dose? Sometimes the doctors listen to me and sometimes they dont so id need to have my facts straight if wanting them to change it. He has his omeproxol via ng and gaviscon mixed with pepti junior

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  • Keep looking at the new posts to the page by others...on the left hand side...

  • My baby is 10weeks (5weeks corrected) and can not sleep on her back at all since this has her coughing and spluttering when not just straight up projectile vomiting. It seems to be worse now she is on thickened formula (alongside omaprozole) esp at night it's like she can't actually spit up the feed anymore (or multiple hours later) as its thicker and therefore she stays choking on it. Does anyone have any nighttime tips it scares me

  • Thank you New Zealand Post.