Gastroesophageal reflux (GER) is the back up of acid or food from the stomach to the esophagus. The esophagus is the tube that connects your 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 can occur at any age.
Gastroesophageal Reflux Disease
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GERD is caused by acid or food from the stomach that regularly backs up into the esophagus. It is not always clear why the acid backs up. The reasons may vary from person to person. There may also be a genetic link in some GERD.
Acid is kept in the stomach by a valve at the top of the stomach. The valve opens when food comes in. It should close to keep in the food and acid. If this valve does not close properly, the acid can flow out of the stomach. In addition to GERD, the valve may not close because of: Problems with the nerves that make the valve open or closeIncreased pressure in the stomachIrritation in the stomach or muscles of the valveProblem with the valve itself
Symptoms of GERD include: Regurgitation or vomitingBloody vomitWeight loss or poor weight gainDifficulty swallowingPain in the abdomen or chest
or respiratory problems
Cough or wheezingHoarsenessDental problems due to the effect of the stomach acid on the tooth's enamelFeeling full almost immediately after eatingChronic heartburn
Your 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 may need to be taken of your stomach and esophagus. This can be done with an
upper GI series
Tests may be done of your bodily tissues. This can be done with an
24-hour pH monitoring—a probe is placed in the esophagus to measure the level of acidShort trial of medications—the doctor may use the success or failure of a medication to understand the cause
Talk with your doctor about the best treatment plan for your child. Treatment options include the following:
Your child's doctor may suggest making lifestyle changes before trying medication. These changes may include:
Eating small, frequent mealsAvoid eating 2-3 hours before bedtimeRaising the head of your child’s bedHaving your child lie on their left side when sleeping
Your child may need to avoid certain foods, such as:
ChocolateFried foodsPeppermintSpicy foodsCaffeine productsCarbonated beveragesFoods high in fat and acidIf your child is obese, your doctor may recommend weight loss.Avoid exposing your child to second hand smoke.
Medications options include: Histamine-2 receptor drugs—to decrease acid production and promote healingProton pump inhibitors—also decreases acid production and promote healingPromotility drugs—to help stomach emptying, not used often
Many of these are over-the-counter medications.
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.
Most causes of GERD in children are unknown. Some cases of GERD may be prevented by: Following recommended lifestyle and dietary changes if your child had GERAvoiding second-hand smoke
GI Kids—North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition
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.
Treating GERD. Ohio State University Medical Center website. Available at:
Accessed May 10, 2013.
3/1/2010 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Maalox Total Relief and Maalox liquid products: Medication use errors. US Food and Drug Administration website. Available at:
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm200672.htm. Published February 17, 2010. Accessed May 10, 2013.
Last reviewed January 2015 by Kari Kassir, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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