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Gastroesophageal Reflux Disease (GERD)

The term gastroesophageal refers to the stomach and esophagus. Reflux means to flow back or return. Therefore, gastroesophageal reflux (GER) is the return of the stomach's contents, usually acid, into the esophagus (the tube that connects the mouth to the stomach) during or after a meal. GER causes inflammation (irritation) and damage (e.g., ulcers) to the esophagus.

Gastroesophageal reflux disease (GERD) occurs when the reflux of food or liquid causes problems with feeding, growing or breathing. It is a digestive disorder that affects the lower esophageal sphincter (LES)—the muscle connecting the esophagus with the stomach. Normally, the LES opens only to allow food into the stomach and otherwise remains closed to keep acidic juices from rising back into the esophagus.

GERD is a frequent concern in infants and children with respiratory diseases, neurological problems, feeding disorders and otherwise healthy children.

Symptoms

In many cases, GERD causes mild symptoms but in some children, GERD can cause significant complications like esophagitis or breathing problems.

Some symptoms may include: 

  • Heartburn
  • Upset stomach
  • Ulcers
  • Cough
  • Sore throat
  • Ear pain
  • Nausea

Causes

There are many reasons why infants have GER. The lower esophageal sphincter (LES) is the gate to the stomach at the end of the esophagus. In infants, reflux occurs when the LES relaxes at inappropriate times. These episodes of LES relaxation occur less often as infants get older. Reflux of stomach contents into the esophagus also may occur when infants eat, cry or strain. Less commonly, reflux can occur as a result of abnormal anatomy, inflammation caused by the stomach acid, allergy or a problem of another body system. 

How is GER and GERD Diagnosed?

Doctors may be able to determine your infant or child has GER by talking with you about your child symptoms and by doing a physical exam. There are also tests that the doctor can use to confirm or rule out GERD.

Tests may include:

  • Upper GI/Barium series – A test where your child is given barium to drink to assess the flow of food through the esophagus and stomach. It looks for abnormal anatomy or blockages. It is not usually done to look for reflux, as reflux can be present in children and not cause problems.
  • 24 hour pH probe – A test where a small tube is inserted through the child’s nose down to the esophagus to measure the acid refluxing up from the stomach over a 12 to 24 hour period.
  • Upper Endoscopy – A test performed while your child is asleep. A small tube is inserted through the mouth and down into the stomach and small intestine. The doctor can see if the lining looks irritated. Small pieces of tissue are biopsied. These are looked at under a microscope to help determine if GER has caused inflammation.
  • Scintiscan/Gastric Emptying Scan – A test where the child is given a drink or meal with a small amount of dye in it. It looks for the presence of reflux and how well the stomach empties. It can also help to determine if stomach contents get into the lungs.

Treatment

Treatment for GERD is different for each child. Treatment for GER and GERD is dependent upon your child’s symptoms and age.

For Infants:

Most infants will outgrow GER by the age of 18 months. If your child is growing and healthy, treatment is usually limited to the suggestions below:

  • Elevate the head of the crib or bed about 30 degrees.
  • If your baby is bottle fed, add up to one tablespoon of rice cereal to 2 ounces of infant milk (includes expressed breast milk).
    • This may be too thick for your infant to easily take through the nipple
    • Experiment with the nipple size, cross cut the nipple or vary the amount of cereal added to a desirable thickness
  • Burp your baby after he has ingested 1 or 2 ounces of formula or after he has completed feeding on one side (breastfed babies)
  • Do not overfeed your infant. Discuss with your doctor the amounts of formula or breastmilk which are appropriate for your child’s size.
  • When possible, hold your infant upright in your arms for 30 minutes after feeding.
  • Discuss sleep positioning with your doctor. Some infants may need to be placed on their sides or stomach when they have GER.

For Older Children:

  • Have him avoid eating 2 to 3 hours before going to bed.
  • Elevate the head of your child's bed 30 degrees and consider placing him (over the age of 3) on a second pillow.
  • Avoid carbonated drinks, chocolate, caffeine and foods that are high in fat, contain a lot of acid (citrus) or spices.

Medications

Medications that help block acid can be used to treat GERD. Some examples include:

  • H2 Receptor antagonists: used to decrease the amount of acid made by the stomach
    • Zantac (Ranitidine)
    • Axid (nizatidine)
    • Pepcid (famotidine)
    • Tagament (Cimetidine)
  • Proton pump inhibitors: used to heal severe inflammation
    • Prilosec (omeprazole)
    • Prevacid (lansoprazole)
    • Nexium (esomeprazole)
    • Aciphex (rabeprazole)
    • Protonix (pantoprazole)

Surgery

Occasionally, a child will have severe enough reflux that surgery will be required.