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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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.
The following factors contribute to GERD: Problems with the nerves that control the LESProblems with LES muscle toneImpaired peristalsis—muscular contractions that propel food toward the stomachAbnormal pressure on the LESIncreased relaxation of the LESIncreased pressure within the abdomen
GERD may cause: Chronic heartburn—most common symptomDifficulty swallowing or choking with feedings
Impaired breathing during sleep—sleep apneaRefusal to eatIncreased mouth secretionsRegurgitation or vomitingBloody vomitWeight loss or poor weight gain
or respiratory problems
Coughing or wheezingHoarsenessArching back while feedingIrritability or restlessness while feeding
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.
Images may need to be taken of your child's stomach and esophagus. This can be done with: Upper GI seriesUpper endoscopy
with biopsyNuclear medicine scan
Other tests may include: 24-hour pH monitoring—a probe is placed in the esophagus to keep track of the acid in the lower esophagusShort trial of medications—success or failure of medication may help your doctor understand the cause
There are 3 goals for treatment. The first is to prevent injury to the esophagus. The second is to make sure your child is eating enough. The third goal is to keep the backed up food and acid from getting into the lungs. This will require a team approach. Your child may work with the pediatrician, specialized doctors, and a variety of therapists.
Talk with the doctor about the best treatment plan for your child. Treatment options include:
It is important that your child is able to get the food needed for good health. GERD can make it difficult for your child to eat. Your doctor may recommend a
feeding tube. This is a tube that is inserted through your child's nose and into the stomach. It will deliver the nutrients your child needs. The feeding tube will also decrease the risk of choking and ease the stress of feeding.
Most GERD in children can be relieved with lifestyle changes. Medication may be given if your child's GERD doesn't improve. Medications can help to decrease acid in the stomach and help the esophagus heal. Medication options may include: H-2 blockersProton pump inhibitors
Many of these are over-the-counter medications that are available in liquid or powder form.
Surgery or endoscopy may be recommended with
more severe cases.
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.
There are no current guidelines to prevent GERD.
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 in infants. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated June 22, 2012. Accessed May 10, 2013.
Pediatric GE reflux clinical practice guidelines.
J Pediatr Gastroenterol Nutr.
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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