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Fawcett Memorial Hospital
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Gastroesophageal Reflux Disease -- Child

Definition

Gastroesophageal reflux (GER) is the back up of acid or food from the stomach to the esophagus. The esophagus is the tube that connects the mouth and stomach. GER is common in infants. It may cause them to spit up. Most infants outgrow GER within 12 months.

GER that progresses to esophageal injury and other symptoms is called gastroesophageal reflux disease (GERD). The backed-up acid irritates the lining of the esophagus. It causes heartburn, a pain in the stomach and chest. GERD requires treatment to avoid complications.

GERD can occur at any age.

Gastroesophageal Reflux Disease
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Copyright © Nucleus Medical Media, Inc.

Causes

The lower esophageal sphincter (LES) is a muscular ring between the esophagus and the stomach. It relaxes to let food pass into the stomach, then closes shut to prevent it from backing up. With GERD, the ring doesn't close as tightly as it normally should. This causes acid reflux, a burning sensation that can be felt below the breastbone.

  • Problems with the nerves that control the LES
  • Problems with LES muscle tone
  • Impaired peristalsis—muscular contractions that propel food toward the stomach
  • Abnormal pressure on the LES
  • Increased relaxation of the LES
  • Increased pressure within the abdomen

Risk Factors

Factors that may increase your child's chance of GERD include:

Symptoms

GERD may cause:

  • Chronic heartburn—most common symptom
  • Regurgitation or vomiting
  • Green or yellow-green vomit
  • Bloody vomit
  • Weight loss or poor weight gain
  • Difficulty swallowing
  • Pain in the abdomen or chest
  • Frequent aspiration pneumonia or respiratory problems
  • Cough or wheezing
  • Hoarseness
  • Dental problems due to the effect of the stomach acid on the tooth's enamel
  • Feeling full almost immediately after eating

Diagnosis

The doctor will ask about your child’s symptoms and medical history. A physical exam will be done. Your child may need to see a pediatric gastroenterologist. This type of doctor focuses on diseases of the stomach and intestines.

Tests may include:

  • Images tests can assess the stomach and esophagus. These may include an upper GI series and/or upper endoscopy with biopsy.
  • 24-hour pH monitoring—A probe is placed in the esophagus to measure the level of acid.
  • Short trial of medications—The doctor may use the success or failure of a medication to understand the cause.

Treatment

Talk with the doctor about the best treatment plan for your child. Treatment options include the following:

Lifestyle Changes

  • Your child's doctor may suggest making lifestyle changes before trying medication. These changes may include:
    • Eating small, frequent meals.
    • Avoid eating 2-3 hours before bedtime.
    • Raising the head of their bed.
    • Having your child lie on their left side when sleeping.
  • Your child may need to avoid certain foods and drinks, such as:
    • Chocolate
    • Fried foods
    • Peppermint
    • Spicy foods
    • Caffeine products
    • Carbonated drinks
    • Foods high in fat and acid
  • If your child is overweight, your doctor will advise you on a safe way to help them lose it.
  • Avoid exposing your child to secondhand smoke.

Medications

Medication may be needed to relieve symptoms and heal any damage to the esophagus. Many medications for GERD are available over-the-counter and by prescription. Your child's doctor may recommend the following:

  • H-2 blockers
  • Proton pump inhibitors
  • Promotility drugs—to help stomach emptying (not used often)

Procedures

Surgery or endoscopy may be recommended for more severe cases. It may be considered if lifestyle changes and medications do not work.

The most common surgery is called fundoplication. During this procedure, a part of the stomach will be wrapped around the stomach valve. This makes the valve stronger. It should prevent stomach acid from backing up into the esophagus. This surgery is often done through small incisions in the skin.

Prevention

There are no current guidelines to prevent GERD.

Revision Information

  • Reviewer: Kari Kassir, MD
  • Review Date: 01/2015 -
  • Update Date: 05/12/2015 -
  • GI Kids—North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

    http://www.gikids.org

  • National Institute of Diabetes and Digestive and Kidney Diseases

    http://www.niddk.nih.gov

  • Canadian Digestive Health Foundation

    http://www.cdhf.ca

  • About Kids Health—The Hospital for Sick Children

    http://www.aboutkidshealth.ca

  • Gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) in children and adolescents. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/ger-and-gerd-in-children-and-adolescents/Pages/facts.aspx. Updated August 2006. Accessed May 10, 2013.

  • Gastroesophageal reflux disease (GERD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 9, 2013. Accessed May 10, 2013.

  • Pediatric GE reflux clinical practice guidelines. J Pediatr Gastroenterol Nutr. 2001;32:S1-S31.

  • Treating GERD. Ohio State University Medical Center website. Available at: http://wexnermedical.osu.edu/patient-care/healthcare-services/digestive-diseases/heartburn. Accessed May 10, 2013.

  • 5/12/2015 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: National Collaborating Centre for Women's and Children's Health. Gastro-oesophageal reflux disease: recognition, diagnosis and management in children and young people. London (UK): National Institute for Health and Care Excellence (NICE); 2015 Jan 14. 34 p. (NICE guideline; no. 1). Available at: http://www.guideline.gov/content.aspx?id=48992#Section420. Accessed May 12, 2015.