GASTROESOPHAGEAL REFLUX DISEASE  (GERD)

Gastroesophageal reflux is defined as the contents of the stomach moving back up into the esophagus.  This occurs naturally in many babies and can cause symptoms and pain or discomfort in some babies and older children and adolescents.  Normally the sphincter (valve) between the esophagus and stomach closes after food passes through it. However, in some children, the valve is floppy, allowing the stomach contents to come back up into the esophagus.

In older children and adolescents the symptoms are regurgitation, chest pain, chronic cough, recurrent pneumonia and asthma. They may also have bleeding from tears and inflammation in the esophagus.

The diagnosis of GERD is mostly made by history and physical examination, but sometimes we may need to do some testing. 

Once the diagnosis is made, we can begin treatment. For older children and adolescents the treatment involves dietary changes, such as eliminating caffeine, chocolate and spicy foods, and weight loss in an obese individual.  Smoking and alcohol also exacerbate reflux and therefore should be avoided.  If these measures don’t help, medication may be necessary.  The first type of medication used is an acid blocker, such as Zantac or Pepcid, which block the effect of the acid on the esophagus.   If that does not work, the next step is a class of medications called proton pump inhibitors.  These medications, such as Prevacid, Prilosec and Nexium, lower the acid secretion in the stomach.

In babies, there is usually spitting up without any pain or other symptoms, which does not need treatment and is outgrown by 8-10 months of age.  Occasionally the acid in the stomach does cause discomfort or pain in babies, although this is more common in the older child who has reflux.

Other symptoms of reflux in babies include upper airway congestion, irritability, weight loss, failure to thrive, and in more severe cases, recurrent pneumonia, asthma, and rarely apnea (not breathing).  When these types of symptoms are present, the reflux may need to be treated.

For the infants, positioning after feeding, thickening formula feeds and observation may be enough. If there are more severe symptoms, we may prescribe medication, such as the acid blockers mentioned above.

If you think your child has symptoms of GERD or you have questions, call our office.



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