Gastro-oesophageal reflux disease (GORD)

Gastro-oesophageal reflux disease (GORD) is common in people with scoliosis, cerebral palsy, Down syndrome, severe to profound intellectual disability, and those who take long-term medications (eg antiepileptics). GORD can be severe, and may be exacerbated by motility disorders or peptic ulceration. People with developmental disability may have difficulty identifying or communicating symptoms; always consider GORD in the following situations:

• challenging behaviour (eg agitation, injury to self or others, pica)
• polydipsia
• recurrent vomiting and aspiration
• recurrent respiratory infections, wheeze or ‘new’ asthma
• coughing, choking or regurgitation with meals
• anaemia
• weight loss
• dental erosions
• sleep disturbance.

In patients who cannot communicate their symptoms well, behaviour charts may be helpful when trying to assess the:

• severity of their symptoms
• effectiveness of treatment.

Endoscopy is required in the presence of alarm symptoms (ie anaemia, dysphagia, haematemesis, melaena, vomiting, weight loss). For information on managing GORD, see Gastrointestinal guidelines.