Reflux

Reflux

What is GERD?

Gastroesophageal reflux disease (GERD) is a chronic digestive disorder that is caused by the abnormal flow of gastric acid from the stomach into the esophagus.

Gastroesophageal refers to the stomach and esophagus, and reflux means to flow back or return. Gastroesophageal reflux (GER) is the return of acidic stomach juices, or food and fluids, back up into the esophagus.

GERD is very common in infants, though it can occur at any age. It is the most common cause of vomiting during infancy.

Illustration demonstrating gastroesophageal reflux
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What causes GERD?

GERD is often the result of conditions that affect the lower esophageal sphincter (LES). 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 or for too long, acid refluxes back into the esophagus, causing vomiting or heartburn.

Everyone has gastroesophageal reflux from time to time. If you have ever burped and had an acid taste in your mouth, you have had reflux. The lower esophageal sphincter occasionally relaxes at inopportune times, and usually, all your child will experience is a bad taste in the mouth, or a mild, momentary feeling of heartburn.

Infants are more likely to experience weakness of the lower esophageal sphincter (LES), causing it to relax when it should remain shut. As food or milk is digesting, the LES opens and allows the stomach contents to go back up the esophagus. Sometimes, the stomach contents go all the way up the esophagus and the infant or child vomits. Other times, the stomach contents only go part of the way up the esophagus, causing heartburn, breathing problems, or, possibly, no symptoms at all.

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:

Other foods increase acid production in the stomach, including:

Why is gastroesophageal reflux (GERD) a concern?

Some infants and children who have gastroesophageal reflux may not vomit, but may still have stomach contents move up the esophagus and spill over into the windpipe. This can cause asthma, pneumonia, and possibly even SIDS (sudden infant death syndrome).

Additionally, infants and children with GERD who vomit frequently may not gain weight and grow normally. Inflammation (esophagitis) or ulcers (sores) can form in the esophagus due to contact with stomach acid. These can be painful and also may bleed, leading to anemia (too few red blood cells in the bloodstream). Esophageal narrowing (stricture) and Barrett's esophagus (abnormal cells in the esophageal lining) are long-term complications from inflammation that are seen in adults.

What are the symptoms of GERD?

Heartburn, also called acid indigestion, is the most common symptom of GERD. Heartburn is described as a burning chest pain that begins behind the breastbone and moves upward to the neck and throat. It can last as long as two hours and is often worse after eating. Lying down or bending over after a meal can also result in heartburn. Most children younger than 12 years of age who are diagnosed with GERD will experience a dry cough, asthma symptoms, or trouble swallowing, instead of classic heartburn.

The following are other common symptoms of GERD. However, each child may experience symptoms differently. Symptoms may include:

The symptoms of GERD may resemble other conditions or medical problems. Consult your child's physician for a diagnosis.

How is GERD diagnosed?

Your child's physician will perform a physical examination and obtain a medical history. Diagnostic procedures that may be done to help evaluate GERD include:

Treatment for GERD

Specific treatment will be determined by your child's physician based on the following:

In many cases, GERD can be relieved through diet and lifestyle changes, under the direction of your child's physician. Some ways to better manage GERD symptoms include the following:

Treatment may include

What is the long-term outlook for a child with GERD?

Many infants who vomit will "outgrow it" by the time they are about a year old, as the lower esophageal sphincter becomes stronger. For others, medications, lifestyle, and diet changes can minimize reflux, vomiting, and heartburn.

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