Gastroesophageal Reflux (GERD)

A disorder that occurs when stomach acid moves backward from the stomach into the esophagus. Gastroesophageal reflux disease (GERD) usually occurs because the muscular valve where the esophagus joins the stomach does not close properly. When the stomach acid comes into contact with the esophagus, it causes a burning sensation. Although many people experience heartburn occasionally, GERD occurs much more often and causes serious discomfort.

Eventually, the reflux of stomach acid damages the tissue lining the esophagus, causing inflammation and pain. No one knows for sure why people get GERD, but more than one million children in the United States have the condition.

Certain foods may be linked to acid reflux, including citrus fruits, chocolate, caffeinated drinks, fatty and fried foods, garlic and onions, mint, spicy foods, and tomato-based foods.

Symptoms
The main symptoms include persistent heartburn and acid regurgitation, although some children do not experience heartburn. Instead, they may have: pain in the chest or stomach; a frequent sour taste of acid, especially when lying down; a hoarse throat; a feeling of burping acid; trouble swallowing; a feeling that food is stuck in their throat; choking feeling; dry cough; or bad breath.

Although a certain amount of reflux is normal in most people, it is sometimes overlooked in infants and children. Acid reflux can cause repeated vomiting, coughing, and other respiratory problems in children as young as newborns. When this happens, it is also called GERD. It is usually caused by an infant’s immature digestive system; most infants stop having acid reflux by the time they reach their first birthday. However, some children do not outgrow acid reflux and continue having problems into adolescence.

Diagnosis
Tests may be used to rule out other possible problems besides GERD. A barium swallow radiograph uses X rays to help spot abnormalities such as a hiatal hernia, ulcer, or severe inflammation. An upper endoscopy is one of the best ways to look for esophagus and stomach damage. A doctor may perform a biopsy during the endoscopy to reveal any damage caused by acid reflux or infection and help rule out other problems. An ambulatory pH monitoring exam measures the appearance of any acid in the esophagus. This test is useful in teens with GERD symptoms but no esophageal damage. It also can detect whether the reflux triggers respiratory symptoms, such as wheezing and coughing.

Treatment
Treatment depends on the severity of symptoms, but may include lifestyle changes, medications, and surgery. Children and teens should lose excess weight, eat small meals, wear loose-fitting clothes over the midsection, and avoid food or beverages with caffeine, such as tea and some sodas. In addition, patients should not lie down for three hours after eating, nor should they eat two to three hours before bedtime. The head of the bed should be raised six to eight inches by putting wooden blocks under the bedposts (extra pillows will not help).

Antacids such as Alka-Seltzer or Maalox, which neutralize stomach acid, can help ease mild symptoms. Other medications called H2 blockers are available with and without prescription; they work by blocking the production of stomach acid. More powerful prescription drugs called proton pump inhibitors also reduce the amount of acid the stomach produces and are often recommended by doctors for severe GERD.

For some children, combinations of medications may be the best way to control symptoms. For example, children who get heartburn after eating can try taking both antacids and H2 blockers (the antacid neutralizes the acid in the stomach while the H2 blocker interferes with acid production). By the time the antacid stops working, the H2 blocker has stopped acid production.

Surgery is a last resort for people with GERD and is rarely needed in otherwise healthy children.