What is gastroesophageal reflux disease (GERD)?

Related links:

• 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 is a condition in which acidic stomach juices, or food and fluids, frequently flow from the stomach into the esophagus. Everyone experiences reflux from time to time — it is especially common in infants — but occasional reflux doesn’t necessarily mean that a child has gastroesophageal reflux disease. GERD causes chronic irritation and inflammation in the stomach and esophageal lining, the pain is more continuous and it affects the quality of the child’s life. It can lead to poor weight gain, respiratory symptoms and other problems.

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 refluxes back into the esophagus, causing vomiting or heartburn.

Infants are more likely to have their 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 longer than normal. These include:

• Chocolate
• Peppermint
• High-fat foods

Other foods increase acid production in the stomach, including:

• Citrus foods
• Tomatoes and tomato sauces

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. Some infants and children may spit up or vomit as a result of reflux, while others may only experience pain. Symptoms could include:

• Belching
• Refusal to eat
• Stomachache
• Fussiness around mealtimes
• Frequent vomiting
• Hiccups
• Gagging
• Choking
• Frequent cough
• Coughing fits at night
• Wheezing
• Frequent upper respiratory infections (colds)
• Rattling in the chest
• Frequent sore throats in the morning
• Sour taste in the mouth

The symptoms of GERD can resemble 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. Although infants frequently experience reflux, it’s 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 and 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.

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:

• Chest X-ray
• Upper GI (gastrointestinal) series
• Endoscopy
• Biopsy
• Esophageal manometric studies
• pH testing
• 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 fried and fatty foods, peppermint, chocolate, drinks with caffeine, citrus fruit and juices and tomato products.
• Offer your child smaller portions at mealtimes and include small snacks in between meals if your child is hungry. Don’t let your child overeat.
• If your child is overweight, consult your physician to set weight loss goals.
• Do not allow your child to 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 (such as a H2 blocker or proton-pump inhibitor) 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 rule out any other potential causes for 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.

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.