Gastroesophageal Reflux Disease (GERD)

Every adult, at one time or another, has experienced heartburn and that gnawing mid-chest discomfort after a big meal. Maybe you had one too many hot dogs at the ballpark, or maybe your cousin's chili was a bit too hot for you.

But when these symptoms are frequent or can't be attributed to spicy ingredients, it could be gastroesophageal reflux disease (GERD). And it can be a problem not just for adults, but for children as young as newborns. In fact, it's not uncommon for infants to experience the post-feeding vomiting and fussiness of GERD. Most will outgrow the disease without medication, but there are some who will need more aggressive treatment.

What Is GERD?

The burping, heartburn, and spitting up that are associated with GERD happen when acidic stomach contents move backward into the esophagus (called reflux). If the lower esophageal sphincter (the muscle that connects the esophagus with the stomach) relaxes or is weak, it can allow stomach contents to reflux.

More than 60 million American adults experience reflux at least once a month, and it's not usually a cause for alarm. Many times, people aren't even aware that they are experiencing reflux.

With GERD, however, reflux occurs more frequently and causes enough discomfort that the person affected is aware of the condition. About 19 million Americans have GERD. After nearly all meals, a person with GERD suffers heartburn, also known as acid indigestion, which feels like a burning sensation in the chest, neck, and throat.

It's normal for babies to occasionally spit up small amounts of formula or breast milk following a feeding, particularly when being burped or during periods of movement. For babies with GERD, however, breast milk or formula regularly refluxes into the esophagus and sometimes out of the mouth. Sometimes babies regurgitate forcefully; other times they experience something like a "wet burp."

Because stomach acid is part of what's refluxed, the esophagus can become irritated, resulting in esophagitis. In some cases, babies with GERD can have choking episodes or develop aspiration pneumonia when stomach contents are refluxed up to the level of the trachea (windpipe) and then into the lungs. Babies with GERD may also experience extended periods without breathing known as apnea. If prolonged, these apneic episodes can be life-threatening.

Signs and Symptoms

Heartburn is the most common symptom of GERD in adults and children, and it can last up to 2 hours and is worse after meals. Those with reflux also may feel like food is coming back up into the mouth, leaving a bitter aftertaste of stomach acid.

The symptoms may be worse if a child or adult lies down or if a baby is held in a face-up position after a meal.

Some foods are thought to make GERD worse. Chocolate, peppermint, fried or fatty foods, caffeine, and alcohol may weaken the lower esophageal sphincter. Studies show that smoking may relax the muscle, as may pregnancy (which may explain why many pregnant women experience heartburn).

Here are the most common signs that your infant or young child may have GERD: