6146 Management of paediaric respiratory patients with suspicion of Gastro-oesophageal Reflux disease

Objectives Gastroesophageal reflux (GOR) is a common physiological process characterized by the intermittent rise of gastric acid contents into the esophagus. When this reflux leads to bothersome symptoms or complications, such as esophagitis or stricture, it is termed Gastroesophageal Reflux Disease (GORD), signifying the pathological nature of gastroesophageal reflux.¹ ²Airway Reflux (AR), categorized under extra-esophageal reflux, pertains to the regurgitation of refluxate beyond the esophagus, affecting the airway.³ GORD is prevalent in respiratory patients, including preterm infants with bronchopulmonary dysplasia (BPD), individuals with neurological impairments requiring Non- Invasive Ventilation (NIV), children with neuromuscular weakness, and those with conditions like Cystic Fibrosis (CF). Additionally, common respiratory issues such as allergic rhinitis can increase the risk of new-onset GORD in children.¹ Clinical implications of AR in children encompass airway stenosis, upper and lower airway inflammation, laryngospasm, acute life-threatening events, apnea, and sudden infant death syndrome.³ Diagnosing GORD and AR can be challenging, particularly in non-verbal patients. This guideline aims to simplify the diagnosis and management of respiratory patients with suspected GORD. Methods In collaboration with a speech and language manager, dietitian, gastroenterology consultant, and respiratory consultant, we developed a comprehensive guideline. Extensive literature was reviewed to inform this guideline, and it underwent thorough evaluation and approval by the Paediatric Respiratory, General Paediatrics, and Paediatric Gastroenterology teams. Results Conclusion Currently, there is no single diagnostic tool that definitively attributes extraesophageal symptoms to Gastroesophageal Reflux Disease (GORD). Assessing the role of GORD in these symptoms necessitates a comprehensive clinical evaluation, including patient-reported symptoms, response to GORD therapy, and findings from endoscopy and impedance-pH testing. Managing refractory GORD can be particularly challenging. In response to this, we have developed a comprehensive guideline to enhance the clinical management of respiratory patients with GORD, aiming to improve the quality of care. We are in the process of planning a full-cycle audit to evaluate the impact of this new guideline on patient management and overall patient satisfaction References Feng MC, Tsai YG, Chang YH, et al. Allergic rhinitis as a key factor for the development of gastroesophageal reflux disease in children. J Microbiol Immunol Infect 2021;54(6):1167–1174. Lechien JR. Pediatric laryngopharyngeal reflux: an evidence-based review. Children (Basel). 2023;10(3):583. Saniasiaya J, Kulasegarah J. The link between airway reflux and non-acid reflux in children: a review. Braz J Otorhinolaryngol 2023 MarApr;89(2):329–338.