I was asked to extend yesterdays report and have done so below.

In the patient without a neurodevelopmental disorder, the symptoms of gastroesophageal reflux include heartburn, dysphagia, regurgitation and occasionally night time awakening with a sensation of suffocating (Harris Jason P. et al., 2003). There is also a group of symptoms described as “atypical” by some observers which include chronic aspiration, cough, hoarseness, asthma, recurrent bronchitis or pneumonia (Bowrey D. et al., 2000). The symptoms in persons with neurodevelopmental disorders are similar for the most part, except for the fact that the non-verbal status of this group may make the presentation more subtle (next pages).

Differential diagnosis should include coronary artery disease, peptic ulcer disease, pancreatitis, biliary colic and esophageal motor disorders such as achalasia or diffuse esophageal spasm (Harris Jason P. et. al., 2003).

Reflux esophagitis and pulmonary aspiration may exist independently of each other or accompany each other. Because of this inter-relationship, any changes in respiratory status should be under suspicion as a symptom of reflux esophagitis (as well as pulmonary aspiration). One must also be aware that in the patient with a neurodevelopmental disorder, symptomatic manifestations may be more subtle due to the patients non-verbal status. Episodes of shortness of breath in the non-verbal patient which are transient and moderate (or even mild) in severity in some cases and are often only noticed by staff who have direct, daily contact with this group of patients, can indicate reflux.

Hope this was of interest.

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