Reflux

Gastroesohaegel (GE) reflux happens when stomach fluids wash back into the esophagus (the tube that brings food from the mouth to the stomach). It occurs in everyone at times, but can become a concern if it happened too often or is very forceful.

Symptoms

  • Heartburn and chest pains
  • Vomiting
  • Repeated swallowing or gagging
  • Fussiness or poor sleep
  • Wheezing of other breathing problems
  • Repeated lung infections or pneumonia
  • Weight loss
  • Failure to gain weight
  • Refusal to eat
  • Abdominal pain
  • Arching of the back

Causes

Conditions that affect the lower esophageal sphincter (LES) often result in reflux. The LES, a muscle located at the bottom of the esophagus, opens to let food in and closes to keep food in the stomach. When this muscle relaxes too often, acid refluxes back into the esophagus, causing vomiting or heartburn. Some foods seem to affect the muscle tone of the lower esophageal sphincter, allowing it to stay open longer than normal. These include, but are not limited to, the following:

  • High-fat foods
  • Chocolate
  • Peppermint
  • Citrus juices (acid production in the stomach)
  • Tomatoes and tomato sauces (acid production in the stomach)

How is Gastroesophageal Reflux Diagnosed?

Gastroesophageal reflux is diagnosed through a complete patient medical history, physical exam as well as procedures which may include:

  • X-rays of the upper and lower GI
  • pH probe: a thin, flexible tube that measures the amount of reflux (or backward flow of stomach acid) into the esophagus or food tube
  • Endoscopy: a lighted, flexible instrument (containing a computer chip and camera that is attached to a TV monitor) examines the upper to lower GI tract for any condition that can cause symptoms.

Treatment

Diet and lifestyle changes are often the first treatment used to prevent reflux. Limiting food intake and eliminating certain foods often helps decrease the reflux, however other treatment may also be needed including:

  • Medications may help the stomach make less acid, prevent excess acid leakage in the stomach or help the stomach empty faster. These medications, that may relieve the heartburn associated with reflux, include:
    • H2-blockers (cimetidine, ranitidine)
    • Proton-pump inhibitors (omeprazole, lansoprazole)  
    • Metoclopramide  
  • Tube feedings, where formula or breast milk is given through a tube that is guided through the nose and throat into the stomach, may be helpful for reflux. The milk that is given in small amounts continuously allows the infant to receive nutrients slowly. 
  • 7 Calorie supplements may be added to cereal and other liquid and soft food to help reduce reflux and gain weight.
  • Surgery may be performed in severe cases of reflux. The fundoplication minimally invasive surgery is done by making small cuts in the abdomen. Then a small tube with a camera on the end is inserted in the cut. The surgical instruments are placed through the other cuts while the surgeon looks at a video monitor to see the stomach and other organs. The top portion of the stomach is wrapped around the esophagus, creating a tight band that greatly decreases reflux.