What is gastroesophageal reflux disease (GERD)?

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• Our services: Caring for children with heartburn, reflux and GERD services

Related tests and treatments:

• Upper GI series
• Endoscopy
• 24-hour pH-impedance probe
• Esophageal manometry
• Gastric emptying study

What is GERD?

Gastroesophageal reflux disease (GERD) is a condition in which acidic stomach juices, food, and fluids, frequently flow from the stomach into the esophagus. Reflux sometimes causes heartburn, which is a burning sensation felt behind the breastbone when stomach acid moves into the esophagus. Occasional heartburn and reflux are not harmful, and the best treatment is usually to avoid things that trigger symptoms. Everybody experiences heartburn and reflux from time to time but have these symptoms frequently can be a sign of GERD or another GI condition. Chronic or frequent GERD can cause irritation and inflammation in the lining of the stomach and esophagus which can give continuous pain and affect the quality of the child’s life. This can lead to poor weight gain, respiratory symptoms and other problems listed below.

What causes GERD?

The lower esophageal sphincter, 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 flows back into the esophagus, causing GERD symptoms.

Infants are more likely than older children to have the lower esophageal sphincter relax when it should remain shut. Sometimes the stomach contents go all the way up the esophagus and the infant or child vomits. Other times, the stomach contents only travel partly up the esophagus which can cause heartburn, breathing problems or no problems at all.

Some foods seem to affect the muscle tone of the lower esophageal sphincter, allowing it to stay open more than normal. These include:

• Chocolate
• Peppermint
• High-fat foods
• Alcohol
• Exposure to tobacco smoke

Other foods increase stomach acid, including:

• Citrus foods
• Spicy foods
• Foods rich in sugar
• Highly processed foods
• Tomatoes and tomato sauces
• Foods or drinks with caffeine

What are the symptoms of GERD?

GERD can affect children in different ways. The most common symptom is heartburn, 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 can also result in heartburn. Symptoms could include:

• Abdominal pain
• Burping
• Refusal to eat
• Stomachache
• Fussiness around mealtimes
• Frequent vomiting
• Hiccups
• Gagging
• Choking
• Difficulty swallowing or painful swallowing
• Nausea
• Frequent cough
• Coughing fits at night
• Poor appetite or feeling full early
• Frequent sore throats in the morning
• Sour taste in the mouth
• Frequent throat clearing

The symptoms of GERD can be similar to other conditions or medical problems. Be sure to consult your child’s doctor for an accurate diagnosis.

Who is at risk of developing this condition?

Children with esophageal disorders, neurological disorders, asthma and cystic fibrosis are more at risk for developing GERD.  Children who are overweight are also at risk.  Although infants often have reflux, it is unusual for an infant to have gastroesophageal reflux disease.

Why is GERD a concern?

If a child’s stomach contents move up the esophagus and spill over into the windpipe, it can cause asthma and pneumonia. Babies and children with GERD who vomit frequently may not gain weight or grow normally. Stomach acid in the esophagus can also cause inflammation (esophagitis) or painful ulcers. If the ulcers bleed, it can lead to anemia. Long-time complications from inflammation can include esophageal narrowing and a condition called Barrett's esophagus, which involves abnormal cells in the esophageal lining.  Children with symptoms of GERD should also be evaluated because some related conditions, such as eosinophilic esophagitis and esophageal achalasia, get progressively worse if untreated.

How is GERD diagnosed/evaluated?

Your child's doctor will perform a physical examination and obtain a medical history. If the doctor suspects GERD, he or she may also use one or more of the following tests to help with diagnosis or check for other underlying conditions:

• Chest X-ray
• Upper GI (gastrointestinal) series
• Endoscopy
• Esophageal manometry
• 24-hour pH-impedance probe
• Gastric emptying study

In many cases, GERD can be relieved through diet and lifestyle changes:

• Some medications can irritate the lining of the stomach or esophagus. Ask your doctor for alternatives if you think that’s the case.
• Limit food triggers noted above
• Offer your child smaller portions at mealtimes and include small snacks in between meals if your child is hungry. Do not let your child overeat.
• If your child is overweight, consult your physician to set weight loss goals.
• Do not let your child lie down or go to bed right after a meal. Serve the evening meal early — at least two hours before bedtime.

If needed, your child’s doctor might prescribe a medication to decrease the amount of stomach acid. Medications are usually stopped after two months once the esophagus has had time to heal.

What happens after treatment?

If your child continues to experience pain or discomfort from frequent reflux, your doctor might recommend other treatment options or additional testing to check for other possible causes of your child’s symptoms.

When should you contact a physician?

Talk to your pediatrician if your child is experiencing heartburn or other reflux symptoms every day or frequently.  Infants should be evaluated if they are losing weight or if they have not outgrown their reflux problem by age 1.

What is the long-term outlook for 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.

How do I live with GERD?

Make your child takes his or her medicine regularly and follows the doctor’s other treatment recommendations for the best results. Lifestyle modifications may not be easy or convenient, but they can go a long way toward helping your child feel better.