Gastroesophageal
Reflux
Also known as
. . . reflux, GE reflux, GER, gastroesophageal reflux disease, GERD
What
is it?
Gastroesophageal
reflux (GER or GERD) occurs when the acid
contents of the stomach flow back, or
reflux, into the esophagus. The esophagus
is the tube that connects the throat and
stomach.
However, the esophagus doesn’t have a protective lining
like the stomach, so the acid from
gastroesophageal reflux causes the lower
part of the esophagus to become inflamed
and painful.
This condition is called reflux
esophagitis.
Who
gets it?
While this health
topic concerns GER in children, anyone can
suffer from GER.
What
causes it?
The cause is
only partially understood; virtually every person experiences the condition sometime in
life. Acid refluxes from
the stomach when the lower esophageal
sphincter (LES) isn’t working properly.
This sphincter is usually tightly closed and opens only when
food passes from the esophagus into the
stomach.
When the LES has problems with pressure and tone, it lets down
its barrier to the reflux of the stomach
contents into the esophagus.
Infants may also have problems with
delayed gastric emptying, which then
creates a buildup of stomach acids.
What
are the symptoms?
The most common
symptoms of GER are heartburn and/or
regurgitation of stomach acids into the
mouth.
Infants with GER may spit up after
feedings; cry inconsolably; cough or choke
during feedings; refuse to eat; arch,
stretch, or stiffen their bodies; and wake
up frequently.
These symptoms may be complicated
by malnutrition, aspiration pneumonia, and
reflux esophagitis. If gastroesophageal
reflux is chronic and untreated, it can
lead to anemia, esophageal narrowing,
esophageal ulcer, and Barrett’s
syndrome, which is a change in the lining
of the esophagus that can lead to
esophageal cancer.
Symptoms usually go away by 12 to 18 months when the child
begins eating more solid foods and sits up
during feedings.
Older children with GER may complain of abdominal pain or
heartburn, have a chronic cough, vomit
after meals, complain of chest pain
unrelated to the heart, and suffer from
repeated respiratory infections, such as
pneumonia.
Uncontrolled or poorly
controlled reflux may have serious side effects, including poor growth, asthma, repeated
lung infections, esophagitis (inflammation of the esophagus), and in some cases, life
threatening episodes of apnea (cessation of breathing). Over many years, uncontrolled GERD
can lead to scarring of the esophagus, and eventually cancerous changes in the esophageal
lining.
How
is it diagnosed?
Your doctor will
carefully examine your child and take a
complete history of symptoms and when they
began.
He or she may ask you to keep a daily log of your child’s
food intake, and when and what type of
symptoms occur.
Your doctor may order screening tests to rule out other
gastrointestinal disorders.
The most common test used to
diagnose GER in children is a measure of
the acidity in the esophagus. Other
tests used for diagnosis include barium
swallow x-rays and endoscopy, where a thin
hollow tube is inserted into the esophagus
to check for esophagitis and Barrett's
syndrome.
What
is the treatment?
GER can usually be
treated with lifestyle and dietary
changes.
These include providing small,
frequent feedings and thickening the
feedings to provide more calories and to
encourage retention.
You should position your child in
an upright position during feedings and
keep the child upright for at least 20
minutes after eating to help the food stay
down.
Avoid using an infant seat
immediately after feedings to decrease
pressure on the stomach.
Your doctor may also recommend
avoiding foods and environmental irritants
that have been identified as aggravating
the condition. It may also be helpful to
raise the head of your child’s crib or
bed by about 6 inches to keep the acid
flowing away from the esophagus during
sleep. Placing
the baby on his or her side may help
relieve the symptoms of GER; however,
always carefully monitor a sleeping infant
because of the risk of sudden infant death
syndrome (SIDS).
The same treatment is generally
used with older children—provide small,
frequent meals and
avoid foods that are irritants, such as tomatoes, chocolate,
and high fat and spicy foods.
In addition, you should avoid
exposure to cigarette smoke, avoid
clothing that is tight around the abdomen,
encourage moderate exercise, and provide
meals at least 1 to 2 hours before your
child sleeps.
Your doctor may recommend antacids
to buffer the stomach acids that are
irritating the esophagus.
If symptoms are severe, your
doctor may recommend drug therapy, such as
receptor antagonists, which reduce and
inhibit acid secretion; prokinetic agents,
which help move
material through the gastrointestinal tract; and proton pump
inhibitors, which block all gastric acid
secretion. Surgical treatment is only
recommended in severe cases of reflux that
fail to respond to at least 3 to 6 months
of medical treatment.
Glossary of Terms
Stomach: the portion of the GI
tract responsible for receiving and temporarily storing swallowed food
Esophagus: the muscular tube that
carries food from the mouth to the stomach
Laparoscopy: the technique of
operating in the abdomen via a small camera and instruments inserted through small poke
holes rather than a single large incision. Also called Minimally Invasive Surgery.
Barium swallow (upper GI): a test
in which contrast material is swallowed in order to take specialized x-rays, which aid in
diagnosis GERD
pH probe: a test in which a small
probe (tube) is inserted via the nose into the esophagus to monitor the exposure of the
esophagus to stomach acid during a 24 hour period.
Self-care
tips
If your child has
been diagnosed with gastroesophageal
reflux (GER), follow your doctor’s
instructions for care and treatment.
Because early treatment is
important, report any symptoms resembling
GER to your doctor immediately.
Physicians who treat Gastroesophageal
Reflux
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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