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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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:

        
  • Premature birth
  • Parents with a history of heartburn or acid regurgitation
  • Down syndrome or intellectual disability
  • Neurological impairments
  • Cerebral palsy
  • Head injury
  • Hiatal hernia
  • Food allergies
  • Obesity
  • Certain medications
  • Exposure to tobacco smoke
  • Narrow or short esophagus
  • Delayed emptying of the stomach
  • 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.