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IS IT REALLY REFLUX OR SHOULD WE CUT TO THE CHASE?
Natalie Durkin, Sophia Raptis, Katherine Fisher, Colin Ball, Shailesh Patel
King's College Hospital NHS Foundation Trust, London, UK
Aim of Study: Ankyloglossia can reduce tongue mobility and interfere with breastfeeding.
Associated symptoms such as irritability, aerophagia, and poor feeding may often be
mistaken as gastro-oesophageal reflux disease (GORD) or colic. We investigated the impact
of frenulotomy on GORD symptoms.
Method: Data was collected prospectively over nine months. A 12-point assessment tool
validated for diagnostic purposes and monitoring symptoms was used (I-GERQ-R). Scores
>16/42 were considered diagnostic for GORD. Patients were assessed on first presentation
and six weeks post-frenulotomy. Three questions were added regarding anti-reflux/colic
medications and time taken for resolution of symptoms. Statistical analysis was performed
using Student's T-Test, p<0.05 considered significant. Institutional approval was granted.
Results presented as median (range).
Main Results: 104 infants were recruited, age 4.5 weeks (2-23.7), 63% male. Age on
assessment post-procedure was 10.5 weeks (8-29.7). Average I-GERQ-R score on
presentation was 16.8 (SD+/-5.5), with 61/104 infants scoring positive for GORD (58%, 95%
CI:48.5%-67.5%). Average score post-frenulotomy was 8.42 (SD+/-5.5), with only 12/104
positive for GORD symptoms (11.5%, 95% CI:5.4%-17.7%), figure 1. This was statistically
significant (p<0.0001).
Five (5%) patients scoring positive on presentation were already on anti-reflux medications.
Treatment was stopped in three cases following improvement of symptoms post-frenulotomy
(score also normalised). Five (5%) patients commenced anti-reflux medication postfrenulotomy, three of whom scored positively throughout. Anti-colic medication was
discontinued in five of six patients post-frenulotomy.
68/104 (65%, 95% CI:55.8%-74.2%) reported improvement of feeding post-frenulotomy,
41.3% within one week. No improvement of symptoms was reported in 11/104 (10.5%, 95%
CI:4.6% to 16.4%), data unavailable for 25 patients.
Conclusions:
1. Breastfeeding problems related to ankyloglossia may be falsely scored as GORD using
the I-GERQ-R tool.
2. Frenulotomy resulted in a reduction of symptoms attributed to GORD.
3. We recommend thorough clinical oral examination in all infants presenting with reflux-type
symptoms to avoid unnecessary medications and investigations.