Gastroesophageal Reflux Disease (GERD)

About GERD

The burping, heartburn, and spitting up associated with GERD are the result of acidic stomach contents moving backward into the esophagus (called reflux). This can happen because the muscle that connects the esophagus with the stomach (the esophageal sphincter) relaxes at the wrong time or doesn't properly close.

Many people have reflux regularly and it's not usually a cause for concern. But with GERD, reflux occurs more often and causes noticeable discomfort. After nearly all meals, GERD causes heartburn, also known as acid indigestion, which feels like a burning sensation in the chest, neck, and throat.

In babies with GERD, breast milk or formula regularly refluxes into the esophagus, and sometimes out of the mouth. Sometimes babies regurgitate forcefully or have "wet burps."

Most babies outgrow GERD between the time they are 1 and 2 years old. But in some cases, GERD symptoms persist. Kids with developmental or neurological conditions, such as cerebral palsy, are more at risk for GERD and can have more severe, lasting symptoms.

Symptoms of GERD

Heartburn is the most common symptom of GERD in kids and teens. It can last up to 2 hours and tends to be worse after meals. In infants and young children, GERD can lead to problems during and after feeding, including:

• frequent regurgitation or vomiting, especially after meals
• choking or wheezing, if the contents of the reflux get into the windpipe and lungs
• wet burps or wet hiccups
• spitting up that continues beyond the first year of life (when it typically stops for most babies)
• irritability or inconsolable crying after eating
• refusal to eat, at all or in limited amounts
• failure to gain weight

These symptoms may be worse if a baby lies down or is placed on in a car seat after a meal.

Complications of GERD

Some children develop complications from GERD. The constant reflux of stomach acid can lead to:

• breathing problems (if the stomach contents enter the trachea, lungs, or nose)
• redness and irritation in the esophagus, a condition called esophagitis
• bleeding in the esophagus
• scar tissue in the esophagus, which can make it difficult to swallow

Because these complications can make eating painful, GERD can interfere with proper nutrition. So if your child isn't gaining weight as expected or is losing weight, it's important to talk with your doctor.

Diagnosing GERD

In older kids, doctors usually can diagnose GERD by doing a physical exam and hearing about the symptoms. Try to keep track of the foods that seem to bring on symptoms in your child — this information can help the doctor determine what's causing the problem.

In younger children and babies, doctors might run these tests to diagnose GERD or rule out other problems:

• Barium swallow. This is a special X-ray that can show the refluxing of liquid into the esophagus, any irritation in the esophagus, and abnormalities in the upper digestive tract. For the test, the child must swallow a small amount of a chalky liquid (barium). This liquid appears on the X-ray and shows the swallowing process.
• 24-hour impedance-probe study. This is considered the most accurate way to detect reflux and the number of reflux episodes. A thin, flexible tube is placed through the nose into the esophagus. The tip rests just above the esophageal sphincter to monitor the acid levels in the esophagus and to detect any reflux that occurs.
• Milk scans. This series of X-ray scans tracks a special liquid as the child swallows it. The scans can show whether the stomach is slow to empty liquids and whether the refluxed liquid is being inhaled into the lungs.
• Upper endoscopy. In this test, doctors directly look at the esophagus, stomach, and a portion of the small intestines using a tiny fiberoptic camera. During the procedure, doctors may also biopsy or take a small sample of the lining of the esophagus to rule out other problems and determine whether GERD is causing other complications.

Treating GERD

Treatment for GERD depends on the type and severity of the symptoms.

In babies, doctors sometimes suggest lightly thickening the formula or breast milk with rice cereal to reduce reflux. Making sure the baby is in a vertical position (seated or held upright) during feedings can also help.

Older kids often get relief by avoiding foods and drinks that seem to trigger GERD symptoms, including:

• citrus fruits
• chocolate
• foods with caffeine
• fatty and fried foods
• garlic and onions
• spicy foods
• tomato-based foods and sauces
• peppermint
  

Doctors may recommend raising the head of a child's bed 6 to 8 inches to minimize reflux that occurs at night. They may also try to address other conditions that can contribute to GERD symptoms, including obesity, alcohol consumption, smoking, and certain medications.

If these measures don't help relieve the symptoms, the doctor may also prescribe medication, such as H2 blockers, which can help block the production of stomach acid, or proton pump inhibitors, which reduce the amount of acid the stomach produces.

Medications called prokinetics are sometimes used to reduce the number of reflux episodes by helping the lower esophageal sphincter muscle work better and the stomach empty faster.

In rare cases, when medical treatment alone doesn't help and a child is failing to grow or develops other complications, a surgical procedure called fundoplication might be an option. This involves creating a valve at the top of the stomach by wrapping a portion of the stomach around the esophagus.

When to Call the Doctor

If your child is experiencing GERD symptoms, talk with your doctor. With proper diagnosis and treatment, kids can get relief and avoid longer-term health problems.

Reviewed by: J. Fernando del Rosario, MD
Date reviewed: June 2011
Originally reviewed by: Mitchell B. Cohen, MD