1. No category

075
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.