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.”

  • Hello - wondering if you can help, my now 5 year old had silent reflux, my 5 month old also has reflux, I saw a specialist in Auckland for my first child but cannot for the life of my remember his name - do you have a list of specialists in Auckland? Many thanks Misty

  • Hi :) just starting my five month old on solids , any foods worse or better for reflux sufferers ? She is quite constipated from losec and gaviscon so also foods that aren't constipating

  • We only have six members in our Hawkes Bay GRSNNZ Local Support Network on Facebook. If you are coping with reflux and living in this area, we would love you to join us. http://www.reflux.cryingoverspiltmilk.co.nz/grsnnz-membership-confidentiality-agreement-form/

    Gastric Reflux Support Network NZ for Parents of Infants & Children Charitable Trust Membership & Confidentiality Agreement Form / Newsletter Admin PageFirst NameLast nameEmailStreet AddressCity/TownAreaPostcodeDo you live in NZ?Country and Area if not NZHome Phone (include area code)Partner's NameE...

  • A large randomized controlled trial has shown benefits of probiotic treatment in an unselected general population of neonates.

  • hi there, im desperate for help. my wee girl is 5 weeks old and has always been unsettled from birth. At first she was constipated and in pain so paed put her on pepti junior and after no improvement added lactulose syrup for bowels. She has a bowel motion now only every 5-6 days so not ideal. over the passed few days she has got alot worse, fussing at feeds, acidy smelling breath, after finishing bottles she squirms in pain, cramps up like a banana, screams/cries etc. she doesnt spill ever and winds pretty well. Clearly something is still not right but have seen 3 paeds and all havent considered silent reflux?? i feel silly going back again but i know they are missing something, could it be reflux?? thanks Nicole

  • I have been reading your website, thank you, it's helped me a lot. 5 weeks with a very unhappy baby is extremely difficult.

  • Do you live in Northland, New Zealand and have a child with gastric reflux? We would love you to become a member of the Gastric Reflux Support Network NZ and join our latest Private Facebook Group - for the Northland GRSNNZ Local Support Network. We currently have five families who would be grateful to have contact with others in the Northland area and share their experiences. We have Local Support Networks throughout NZ and set up Private Facebook Groups as requested. We already have Yahoo Mailing Lists for each region, but many prefer Facebook. To join complete a membership and confidentiality form: http://www.reflux.cryingoverspiltmilk.co.nz/grsnnz.../ Membership is free, and this gives you opportunities to discuss gastric reflux related issues with others in a safe, private and confidential setting. You will also get access to our newsletters.

    Gastric Reflux Support Network NZ for Parents of Infants & Children Charitable Trust Membership & Confidentiality Agreement Form / Newsletter Admin PageFirst NameLast nameEmailStreet AddressCity/TownAreaPostcodeDo you live in NZ?Country and Area if not NZHome Phone (include area code)Partner's NameE...

  • Hi there, I was on your website reading that doctors should prescribe the Losec granules instead of the suspension. Does this apply for 2 month old babies as well?

  • I am hijacking this photo. #gastricreflux

  • Hi, I am interested in people's opinion on advice from a dietician re my 13 month son who has reflux and lower GI issues, both currently well managed. I have posted before: he's on a restricted diet - no dairy, soy, gluten as well as a random no tomato/potato (latter done by me without paed knowledge following nasty flare up). He is still bf and not a great solids eater - picky, limited finger foods only, no mush. He is small (prem, lbw) but not at all underweight for size. He is on iron supplement (formerly anaemic) and trying to wean off losec. Dietician wants us a) to go on to neocate advanced and b) to reintroduce gluten. Neither of these sit well with me. I ate non-GF oats and small amount non-GF pasta yesterday - now I have an unsettled boy stretching and groaning after a month of calm. Coincidence?? Re neocate - is it really necessary to give him this or can I find the iron and vitamin boost elsewhere? He hates the taste and doesn't eat porridge/mash/stewed fruit to mix it into. The dietician really p***ed me off for her manner and lack of knowledge of son's history (in spite of having met before) and I don't trust her judgment. Thoughts? Sorry long post. Thank you for reading.

  • https://www.youtube.com/watch?v=qTHhWf_hGJI

    Pyrosis RGO mécanisme

  • On 16/02/2014, this page reached 2000 likes. we now have 2059 likes with a total of 23 new likes last week. We hope this page and our website, www.cryingoverspiltmilk.co.nz is helping support your families coping with gastric reflux. If you are in NZ, and want to have support in a confidential setting with other families, please complete our membership form: http://www.reflux.cryingoverspiltmilk.co.nz/grsnnz-membership-confidentiality-agreement-form/ We currently have around 700 members.

    For infant and child gastric reflux support in New Zealand: Phone/Text 022 585 5935 Phone 0800 380 517 Contact GRSNNZ via email form ...parenting reflux babies really is a massive task... I stumbled over your website when I was researching dairy intolerance (which I have). I’m really glad...