Gastroesophageal Reflux

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What is gastroesophageal reflux?

Gastroesophageal reflux (GER) occurs when the stomach contents reflux or go into the esophagus (the tube that connects the mouth to the stomach), during or after a meal. Most infants with gastroesophageal reflux are happy and healthy even though they spit up or vomit. An infant with gastroesophageal reflux may experience:

  • Spitting
  • Vomiting
  • Coughing
  • Irritability
  • Poor feeding
  • Discomfort with feeding

Why does reflux happen?

There is a ring of muscle at the bottom of the esophagus, which opens and closes, allowing food to enter the stomach. This ring of muscle is called the lower esophageal sphincter (LES).

In infants, this sphincter is not as strong as that in older children and adults. The sphincter easily opens and the stomach contents often go up the esophagus and out the mouth (spitting up or vomiting).

Gastroesophageal reflux can also occur when babies cough, cry or strain as the pressure in their stomachs increases at these times.

What are the worrisome symptoms of gastroesophageal reflux?

In a small number of babies, gastroesophageal reflux may result in symptoms that are concerning. These include problems such as:

  • Poor growth due to an inability to hold down enough food
  • Irritability or feeding refusal due to pain
  • Blood loss from acid burning the esophagus
  • Breathing problems

Each of these problems can be caused by disorders other than gastroesophageal reflux. Your healthcare provider needs to determine if gastroesophageal reflux is causing your child’s symptoms.

How does your healthcare provider know your child has reflux?

An infant that spits or vomits may have gastroesophageal reflux. The doctor or nurse will talk with you about your child’s symptoms and perform a physical examination. If the infant is healthy, happy and growing well, no treatment or testing may be needed.

Sometimes, tests may be ordered to help the doctor or nurse determine whether your child’s symptoms are related to gastroesophageal reflux. Often, treatment is started without the need for any tests.

How is reflux treated?

The treatment of reflux depends upon the infant’s symptoms and age. Some babies may not need any treatment, as gastroesophageal reflux will resolve in many cases without treatment. Healthy, happy babies may only need the feedings thickened with cereal and to be kept upright after they are fed.

Overfeeding can aggravate reflux, and your health care provider may suggest a different feeding schedule. For example, smaller volume with more frequent feedings can help decrease the chances of reflux.

If a food allergy is suspected your health care provider may ask you to change the baby’s formula (or modify the mother’s diet if the baby is breastfed). If a child is not growing well, feedings with higher calorie content or tube feedings may be recommended.

If your child is uncomfortable, or has difficulty sleeping, eating or growing, the doctor may suggest a medication. Different types of medicine can be used to treat reflux by decreasing the acid in the stomach.

Although these medications will help protect your child’s esophagus from damage due to reflux, the medicines are unlikely to completely cure the spitting up.

Around 5% of infants have severe gastroesophageal reflux that prevents them from growing or that causes breathing problems. Some of these infants require surgery for gastroesophageal reflux. If surgery is necessary, a valve is created at the junction of the esophagus and stomach (Nissen fundoplication) to eliminate the regurgitation or reflux of stomach contents (acid, bile, food) into the esophagus, airway, mouth. The operation is performed utilizing minimally invasive techniques (five tiny incisions) that reduces the operative stress on the baby and allows for a more rapid recovery than the traditional open operation done through a large incision. Nearly, all babies will require a temporary gastrostomy to permit burping and supplemental feeding if necessary. The tube can be removed once the baby is off bottle feeding, able to burp, and demonstrates consistent weight gain.

 

Gastroesophageal Reflux in Children and Adolescents

 

What is gastroesophageal reflux?

Gastroesophageal reflux (GER) occurs when stomach contents reflux or go up into the esophagus (the tube that connects the mouth to the stomach), during or after a meal.

In some children, the stomach contents go up in the mouth and are swallowed again. Other symptoms include hoarseness, recurrent pneumonia, cough, wheezing and difficulty breathing or swallowing.

Why does reflux happen?

There is a ring of muscle at the bottom of the esophagus that opens and closes, allowing food to enter the stomach. This ring is called the lower esophageal sphincter (LES). Reflux can occur when the LES opens, allowing stomach contents and acid to come back up into the esophagus. Almost all children and adults have a bit of reflux, without being aware of it.

When refluxed material rapidly returns to the stomach, it causes no damage to the esophagus. In some children, reflux occurs very frequently or does not clear from the esophagus, causing damage to the lining of the esophagus. When the refluxed material passes into the back of the mouth or enters the airways, the child may become hoarse, have a raspy voice or a chronic cough.

How does your health care provider know your child has reflux?

The doctor or nurse will talk with you about your child’s symptoms, do a physical examination and may recommend tests to determine if reflux is the cause of symptoms. Often however, treatment is sometimes started without the need for any tests.

What are the most common tests used to diagnose GER?

The Upper GI Series X-ray

Barium (a chalky drink) is swallowed and X-rays show the shape of the esophagus and stomach. This test can find a hiatal hernia, blockage and other problems that might mimic reflux.

Endoscopy

After the patient is given a sedative medication so they are asleep, a small flexible tube with a very tiny camera is inserted through the mouth and down into the esophagus and stomach. The lining of the esophagus, stomach and small intestine can be examined and biopsies (small pieces of the lining) can be painlessly obtained. The biopsies can later be examined with a microscope, looking for inflammation and other problems.

Esophageal pH Probe

A thin light wire with an acid sensor at its tip is inserted through the nose into the lower part of the esophagus. The probe then detects and records the amount of stomach acid coming back up into the esophagus when the child has symptoms such as crying, arching or coughing.

How is reflux treated?

The treatment of reflux depends upon the child’s symptoms and age. When a child or teenager is uncomfortable, or has difficulty sleeping, eating or growing, the doctor or nurse may first suggest a trial of medication. Medications used to treat reflux aim to decrease the amount of acid made in the stomach.

If the child continues to have symptoms despite the initial treatment, tests may be ordered to help find better treatments. Some children require surgery for GER. If surgery is necessary, a valve is created at the junction of the esophagus and stomach (Nissen fundoplication) to eliminate the regurgitation or reflux of stomach contents (acid, bile, food) into the esophagus, airway and mouth. The operation is performed utilizing minimally invasive techniques (five tiny incisions) that reduces operative stress and allows for a more rapid recovery than the traditional open operation done through a large incision. Typically children will begin feeding the day after surgery and are discharged home in two to three days. Morevover, many children are back in school and most activities by one week after the operation.

Your child’s doctor or nurse can discuss the treatment options with you and help your child feel well again.

 

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