Gastroesophageal reflux disease (GERD)

What is GERD?

Gastroesophageal reflux disease is a chronic digestive disorder that is caused by the abnormal flow of gastric acid from the stomach into the esophagus.

Gastroesophageal refers to the stomach and esophagus, and reflux means to flow back or return. Gastroesophageal reflux (GER) is the return of acidic stomach juices, or food and fluids, back up into the esophagus.

GER is very common in infants, though it can occur at any age. It is the most common cause of vomiting during infancy.

Prevention & Risk Treatment

Prevention & Risk Treatment

What causes GERD?

GERD is often the result of conditions that affect the lower esophageal sphincter (LES). The LES, a muscle located at the bottom of the esophagus, opens to let food into the stomach 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.

Everyone has gastroesophageal reflux from time to time. If you have ever burped and had an acid taste in your mouth, you have had reflux. The lower esophageal sphincter occasionally relaxes at inopportune times, and usually, all your child will experience is a bad taste in the mouth, or a mild, momentary feeling of heartburn.

Infants are more likely to experience weakness of the lower esophageal sphincter (LES), causing it to relax when it should remain shut. As food or milk is digesting, the LES opens and allows the stomach contents to go back up the esophagus. Sometimes, the stomach contents go all the way up the esophagus and the infant or child vomits. Other times, the stomach contents only go part of the way up the esophagus, causing heartburn, breathing problems, or, possibly, no symptoms 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, but are not limited to, the following:

  • Chocolate
  • Peppermint
  • High-fat foods

Other foods increase acid production in the stomach, including:

  • Citrus foods
  • Tomatoes and tomato sauces

Why is GERD a concern?

Some infants and children who have GER may not vomit, but may still have stomach contents move up the esophagus and spill over into the windpipe (the trachea), which can cause asthma and/or pneumonia.

Infants and children with GERD who vomit frequently may not gain weight and grow normally. Inflammation (esophagitis) or ulcers (sores) can form in the esophagus due to contact with stomach acid. These can be painful and also may bleed, leading to anemia (too few red blood cells in the bloodstream). Esophageal narrowing (stricture) and Barrett's esophagus (abnormal cells in the esophageal lining) are long-term complications from inflammation that are seen in adults.

What are the symptoms of GERD?

Heartburn, also called acid indigestion, is the most common symptom of GERD. Heartburn is described as 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 after a meal can also contribute to heartburn. Most children younger than 12 years of age who are diagnosed with GERD will experience a dry cough, asthma symptoms, or trouble swallowing, instead of classic heartburn.

The following are other common symptoms of GERD. However, each child may experience symptoms differently. Symptoms may 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)
  • Frequent ear infections
  • Rattling in the chest
  • Frequent sore throat in the morning
  • Sour taste in the mouth

The symptoms of GERD may resemble other conditions or medical problems. Consult your child's doctor for a diagnosis.

Diagnosis

Diagnosis

How is GERD diagnosed?

Your child's doctor will perform a physical examination and obtain a medical history. Diagnostic procedures that may be done to help evaluate GERD include:

  • Chest X-ray. A diagnostic test to look for evidence aspiration -- the movement of stomach contents into the lungs.
  • Upper GI (gastrointestinal) series. A diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky liquid used to coat the inside of organs so that they will show up on an X-ray) is swallowed. X-rays are then taken to evaluate the digestive organs for evidence of ulceration or abnormal blockages.
  • Endoscopy. A test that uses a small, flexible tube with a light and a camera lens at the end (endoscope) to examine the inside of part of the digestive tract. Tissue samples from inside the digestive tract may also be taken for examination and testing.
  • Esophageal manometric study. A test that helps determine the strength of the muscles in the esophagus. It is useful in evaluating gastroesophageal reflux and swallowing abnormalities. A small tube is guided into the nostril, then passed into the throat, and finally into the esophagus. The pressure the esophageal muscles produce is then measured.
  • pH monitoring. To measure the acidity inside of the esophagus. It is helpful in evaluating the extent of GERD. A thin plastic tube is placed into a nostril, guided down the throat, and then into the esophagus. The tube stops just above the lower esophageal sphincter, which is at the connection between the esophagus and the stomach. The end of the tube inside the esophagus contains a sensor that measures pH, or acidity. The other end of the tube outside the body is connected to a monitor that records the pH levels for a 24- to 48-hour period. Normal activity is encouraged during the study, and a diary is kept of symptoms experienced, or activity that might be suspicious for reflux, such as gagging or coughing. It is also recommended to keep a record of the time, type, and amount of food eaten. The pH readings are evaluated and compared with the patient's activity for that time period to help determine possible GERD triggers.
  • Gastric emptying study. A test designed to determine if the stomach releases its contents into the small intestine properly. Delayed gastric emptying can contribute to reflux into the esophagus.
Children's Team

Children's Team

Providers

John Snyder

Division Chief, Gastroenterology, Hepatology, and Nutrition
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