Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is a digestive disorder that is caused by gastric acid flowing 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.

Some infants and children who have gastroesophageal reflux may not vomit, but may still have stomach contents move up the esophagus and spill over into the windpipe. This can cause asthma, pneumonia and possibly SIDS (sudden infant death syndrome).

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.

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 in 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 have the lower esophageal sphincter (LES) 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, possibly causing heartburn or breathing problems.

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
• Citrus foods
• Tomatoes and tomato sauces

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 can also result in heartburn. The following are other common symptoms of GERD. However, each child may experience symptoms differently. Symptoms may include:

• Belching
• Refusal to eat
• Stomachache
• Hiccups
• Gagging
• Choking
• Frequent cough
• Wheezing
• Frequent upper respiratory infections (colds)
• Sour taste in the mouth

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

How Is GERD Diagnosed?

Your child's physician 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 of aspiration.
• Upper GI (gastrointestinal) series - A diagnostic test that examines the organs of the upper part of the digestive system. 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.
• 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.
• Esophageal manometric studies
• pH testing
• Gastric emptying studies

How is GERD Treated?

Specific treatment will be determined by your child's physician based on the following:

• Your child's age, overall health, and medical history
• The extent of the disease
• Your child's tolerance for specific medications, procedures or therapies
• The expectations for the course of the disease
• Your opinion or preference

In many cases, GERD can be relieved through diet and lifestyle changes, under the direction of your child's physician. Some ways to better manage GERD symptoms include the following:

• Ask your child's physician to profile any of the medications they’re taking - some may irritate the lining of the stomach or esophagus.
• Watch your child's food intake - limit fried and fatty foods, peppermint, chocolate, drinks with caffeine (such as colas, Mountain Dew™, and tea), citrus fruit and juices, and tomato products.
• Offer your child smaller portions at mealtimes, and include small snacks in-between meals if your child is hungry. Avoid letting your child overeat. Allow them to let you know when they’re is hungry or full.
• If your child is overweight, consult their physician to set weight loss goals.
• Do not allow your child to lie down or go to bed right after a meal. Serve the evening meal early - at least two hours before bedtime.
• After feedings, place your infant on their stomach with the upper body elevated at least 30° F, or hold them in a sitting position in your lap for 30 minutes.
• If bottle-feeding, keep the nipple filled with milk, so your infant does not swallow too much air while eating. Try different nipples to find one that allows your baby's mouth to make a good seal with the nipple during feeding.
• Adding rice cereal to feeding may be beneficial for some infants.
• Burp your baby several times during bottle or breastfeeding. Your child may reflux more often when burping with a full stomach.

If needed, your child's physician may prescribe medications to help with reflux or other treatment methods.

What Is the Long-term Outlook for GERD?

Many infants who vomit will "outgrow it" by the time they are about a year old, as the lower esophageal sphincter becomes stronger. For others, medications, lifestyle and diet changes can minimize reflux, vomiting, and heartburn.