Gastroesophageal Reflux (GER)

High-Risk Newborns - Gastroesophageal Reflux (GER)

What is GER?

Gastroesophageal reflux is a 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 is the return of acidic stomach juices, or food and fluids, back up into the esophagus.

Gastroesophageal reflux is common in babies, although it can occur at any age. It is the most common cause of vomiting during infancy. It may be a temporary condition, or may become a long-term physical problem, often called gastroesophageal reflux disease (GERD).

Illustration demonstrating gastroesophageal reflux
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What causes GER?

Gastroesophageal reflux 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 into the stomach 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 nausea, vomiting, or heartburn.

As infants digest their feedings, the LES may open and allow the stomach contents to go back up into the esophagus. Sometimes, the stomach contents go all the way up the esophagus and the baby 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.

Why is GER a concern?

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

Babies with GER 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 ulcers can become 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 typically occur in adults.

What are the symptoms of GER?

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

The symptoms of GER may resemble other conditions or medical problems. Always consult your baby's doctor for a diagnosis.

How is GER diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures that may be performed to help evaluate gastroesophageal reflux include:

What is the treatment for GER?

Specific treatment for gastroesophageal reflux will be determined by your baby's doctor based on:

In many cases, GER can be relieved through feeding changes, under the direction of your baby's doctor. Some ways to better manage GER symptoms include the following:

Treatment may include:

Many babies with GER will "outgrow it" by the time they are about a year old, as the lower esophageal sphincter becomes stronger. But always remember to check with your baby's doctor before elevating the head of the crib if your child has been diagnosed with GER. This is for safety reasons and to reduce the risk for SIDS and other sleep-related infant deaths.

For others, medications, lifestyle, and dietary changes can minimize reflux, vomiting, and heartburn. Surgery to reinforce the lower esophageal sphincter and mechanically discourage reflux may be required in severe cases.

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