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.
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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.
- 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
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
- Certain medications
- Exposure to tobacco smoke
- Narrow or short esophagus
- Delayed emptying of the stomach
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 respiratory problems
- Cough or wheezing
- Dental problems due to the effect of the stomach acid on the tooth's enamel
- Feeling full almost immediately after eating
You will be asked 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 be needed of your child's stomach and esophagus A biopsy may be done at the same time. Images can be done with:
Other tests may include:
- 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.
Talk with the 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 meals
- Avoid eating 2-3 hours before bedtime
- Raising the head of your child's bed
- Having your child lie on his or her left side when sleeping
Your child may need to avoid certain foods and drinks, such as:
- Fried foods
- 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 your child return to a healthy weight.
- Avoid exposing your child to secondhand smoke.
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 advise the following:
- H-2 blockers
- Proton pump inhibitors
- Promotility drugs—to help stomach emptying (not used often)
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.
GI Kids—North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition http://www.gikids.org
National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov
About Kids Health—The Hospital for Sick Children http://www.aboutkidshealth.ca
Canadian Digestive Health Foundation http://www.cdhf.ca
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. Accessed March 19, 2018.
Gastroesophageal reflux disease (GERD). EBSCO DynaMed Plus website. Available at: https://www.dynamed.com/topics/dmp~AN~T116914/Gastroesophageal-reflux-disease-GERD . Updated September 14, 2017. Accessed March 19, 2018.
Pediatric GE reflux clinical practice guidelines. J Pediatr Gastroenterol Nutr. 2001;32:S1-S31.
Treating GERD. Ohio State University Medical Center website. Available at: http://wexnermedical.osu.edu/patient-care/healthcare-services/digestive-diseases/heartburn. Accessed March 9, 2016.
5/12/2015 DynaMed Plus Systematic Literature Surveillance https://www.dynamed.com/topics/dmp~AN~T116914/Gastroesophageal-reflux-disease-GERD : National Collaborating Centre for Women's and Children's Health. Gastro-oesophageal reflux disease: recognition, diagnosis and management in children and young people. London (UK): National Institute for Health and Care Excellence (NICE); 2015 Jan 14. 34 p. (NICE guideline; no. 1). Available at: http://www.guideline.gov/content.aspx?id=48992#Section420. Accessed March 9, 2016.
- Reviewer: EBSCO Medical Review Board Kari Kassir, MD
- Review Date: 03/2018
- Update Date: 05/12/2015