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Definition

Gastroesophageal reflux (GER) is the back up of acid or food from the stomach to the esophagus. The esophagus is the tube that connects your mouth and stomach. GER is common in infants. It may cause them to spit up. Most infants outgrow GER within 12 months.

GER that progresses to esophageal injury and other symptoms is called gastroesophageal reflux disease (GERD). The backed-up acid irritates the lining of the esophagus. It causes heartburn, a pain in the stomach and chest.

GERD can occur at any age.

Gastroesophageal Reflux Disease
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Causes

GERD is caused by acid or food from the stomach that regularly backs up into the esophagus. It is not always clear why the acid backs up. The reasons may vary from person to person. There may also be a genetic link in some GERD.

Acid is kept in the stomach by a valve at the top of the stomach. The valve opens when food comes in. It should close to keep in the food and acid. If this valve does not close properly, the acid can flow out of the stomach. In addition to GERD, the valve may not close because of:

  • Problems with the nerves that make the valve open or close
  • Increased pressure in the stomach
  • Irritation in the stomach or muscles of the valve
  • Problem with the valve itself

Risk Factors

The following factors increase the chances of developing GERD:

Symptoms

Symptoms of GERD include:

  • Regurgitation or vomiting
  • Bloody vomit
  • Weight loss or poor weight gain
  • Difficulty swallowing
  • Pain in the abdomen or chest
  • Frequent pneumonia or respiratory problems
  • Cough or wheezing
  • Hoarseness
  • Dental problems due to the effect of the stomach acid on the tooth's enamel
  • Feeling full almost immediately after eating
  • Chronic heartburn

Diagnosis

Your doctor will ask about your child’s symptoms and medical history. A physical exam will be done. Your child may need to see a pediatric gastroenterologist. This type of doctor focuses on diseases of the stomach and intestines.

Tests may include:

  • Images may need to be taken of your stomach and esophagus. This can be done with an upper GI series .
  • Tests may be done of your bodily tissues. This can be done with an upper endoscopy with biopsy.
  • 24-hour pH monitoring—a probe is placed in the esophagus to measure the level of acid
  • Short trial of medicine—the doctor may use the success or failure of a medication to understand the cause

Treatment

Talk with your doctor about the best treatment plan for your child. Treatment options include the following:

Lifestyle Changes

  • Your child's doctor may suggest making lifestyle changes before trying medication. These changes may include:
    • Eating small, frequent meals
    • Avoid eating 2-3 hours before bedtime
    • Raising the head of your child’s bed
    • Having your child lie on their left side when sleeping
  • Your child may need to avoid certain foods, such as:
    • Chocolate
    • Fried foods
    • Peppermint
    • Spicy foods
    • Caffeine products
    • Carbonated beverages
    • Foods high in fat and acid
  • If your child is obese, your doctor may recommend weight loss.
  • Avoid exposing your child to second hand smoke.

Medications

Medications options include:

  • Histamine-2 receptor drugs—to decrease acid production and promote healing
  • Proton pump inhibitors—also decreases acid production and promote healing
  • Promotility drugs—to help stomach emptying, not used often

Many of these are over-the-counter medications.

Procedures

Surgery or endoscopy may be recommended for more severe cases. It may be considered if lifestyle changes and medications do not work.

The most common surgery is called fundoplication . During this procedure, a part of the stomach will be wrapped around the stomach valve. This makes the valve stronger. It should prevent stomach acid from backing up into the esophagus. This surgery is often done through small incisions in the skin.

Prevention

Most causes of GERD in children are unknown. Some cases of GERD may be prevented by:

  • Following recommended lifestyle and dietary changes if your child had GER
  • Avoiding second-hand smoke

Revision Information

  • Reviewer: Michael Woods
  • Review Date: 05/2013 -
  • Update Date: 03/18/2013 -
  • North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

    http://cdhnf.org

  • National Digestive Diseases Information Clearinghouse (NDDIC)

    http://digestive.niddk.nih.gov

  • About Kids Health

    http://www.aboutkidshealth.ca

  • Canadian Digestive Health Foundation

    http://www.cdhf.ca

  • Gastroesophageal reflux disease (GERD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 9, 2013. Accessed May 10, 2013.

  • Gastroesophageal reflux in children and adolescents. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gerinchildren/index.htm . Updated August 2006. Accessed May 10, 2013.

  • Pediatric GE reflux clinical practice guidelines. J Pediatr Gastroenterol Nutr. 2001;32:S1-S31.

  • Treating GERD. Ohio State University Medical Center website. Available at: http://medicalcenter.osu.edu/patientcare/healthcare%5Fservices/digestive%5Fdisorders/gerd%5Fheartburn/diagnosing%5Ftreating%5Fgerd/treating%5Fgerd/Pages/index.aspx . Accessed May 10, 2013.

  • 3/1/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Maalox Total Relief and Maalox liquid products: medication use errors. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm200672.htm . Published February 17, 2010. Accessed March 2, 2010.