Gastroesophageal Reflux Disease (GERD)

Many adults, at one time or another, have experienced heartburn and an uncomfortable feeling in the chest after a big meal, or after eating spicy foods.
When these symptoms are frequent or can't be attributed to certain ingredients, they may be due to gastroesophageal reflux disease (GERD). And the condition isn't just a problem for adults, it affects kids too. In infants, GERD can cause vomiting and fussiness after feeding. And in older kids and teens, GERD can lead to heartburn, stomach, and chest discomfort. Most kids outgrow GERD on their own, but some cases require treatment.
About GERD
The burping, heartburn, and spitting up associated with GERD are the result of acidic stomach contents moving backward into the esophagus (called reflux). This can happen because the muscle that connects the esophagus with the stomach (the esophageal sphincter) relaxes at the wrong time or doesn't properly close.
In babies with GERD, breast milk or formula regularly refluxes into the esophagus, and sometimes out of the mouth. Sometimes babies regurgitate forcefully or have "wet burps."
Most babies outgrow GERD between the time they are 1 and 2 years old. But in some cases, GERD symptoms persist. Kids with developmental or neurological conditions, such as cerebral palsy, are more at risk for GERD and can have more severe, lasting symptoms.
Symptoms of GERD
In infants and young children, GERD can lead to problems during and after feeding, including:
  • frequent regurgitation or vomiting, especially after meals
  • choking or wheezing, if the contents of the reflux get into the windpipe and lungs
  • wet burps or wet hiccups
  • spitting up that continues beyond the first year of life (when it typically stops for most babies)
  • irritability or inconsolable crying after eating
  • refusal to eat, at all or in limited amounts
  • failure to gain weight

These symptoms may be worse if a baby lies down or is placed on in a car seat after a meal.
Complications of GERD
Some children develop complications from GERD. The constant reflux of stomach acid can lead to:

  • breathing problems (if the stomach contents enter the trachea, lungs, or nose)
  • redness and irritation in the esophagus, a condition called esophagitis
  • bleeding in the esophagus
  • scar tissue in the esophagus, which can make it difficult to swallow

Because these complications can make eating painful, GERD can interfere with proper nutrition.

Diagnosing GERD
In older kids, doctors usually can diagnose GERD by doing a physical exam and hearing about the symptoms. In younger children and babies, doctors might run these tests to diagnose GERD or rule out other problems:
Barium swallow: This is a special X-ray that can show the refluxing of liquid into the esophagus, any irritation in the esophagus, and abnormalities in the upper digestive tract. For the test, the child must swallow a small amount of a chalky liquid (barium). This liquid appears on the X-ray and shows the swallowing process.
24-hour pH-probe study: This is considered the most accurate way to diagnose reflux. A thin, flexible tube is placed through the nose into the esophagus. The tip rests just above the esophageal sphincter to monitor the acid levels in the esophagus. If the test finds consistently high acid levels, it can be a sign of GERD.
Milk scans: This series of X-ray scans tracks a special liquid as the child swallows it. The scans can show whether the stomach is slow to empty liquids, and whether the refluxed liquid is being inhaled into the lungs.
Upper endoscopy. In this test, doctors directly look at the esophagus, stomach, and a portion of the small intestines using a tiny fiberoptic camera. During the procedure, doctors may also biopsy or take a small sample of the lining of the esophagus to rule out other problems and determine whether GERD is causing other complications.
Treating GERD
Treatment for GERD depends on the type and severity of a child's symptoms. In babies, doctors sometimes suggest lightly thickening the formula or breast milk with rice cereal to reduce reflux. Making sure the baby is in a vertical position (seated or held upright) during feedings can also help. If these measures don't help relieve the symptoms, the doctor may also prescribe medication, such as H2 blockers, which can help block the production of stomach acid, or proton pump inhibitors, which reduce the amount of acid the stomach produces.
In rare cases, when medical treatment alone doesn't help and a child is failing to grow or develops other complications of reflux, a surgical procedure called fundoplication may be an option. The procedure involves creating a valve at the top of the stomach by wrapping a portion of the stomach around the esophagus.

 
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