See also:

• Gastroesophageal Reflux Disease/Heartburn—Overview
• Gastroesophageal Reflux Disease—Adolescent
• Gastroesophageal Reflux Disease—Child
• Gastroesophageal Reflux Disease—Infant

Definition

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. Children with disabilities are at greater risk for these conditions.

Gastroesophageal Reflux Disease

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Causes

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.

The following factors contribute to GERD:

• 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

Risk Factors

Factors that may increase your child’s chance of GERD include:

• Birth defects
• Neurological impairment
• Premature birth
• Down syndrome or intellectual disability
• Cerebral palsy
• Head injury
• Hiatal hernia
• Food allergies
• Obesity
• Certain medications
• Exposure to tobacco smoke
• Narrow or short esophagus
• Delayed emptying of the stomach

Symptoms

GERD may cause:

• Chronic heartburn—most common symptom
• Difficulty swallowing or choking with feedings
• Impaired breathing during sleep
• Refusal to eat
• Increased mouth secretions
• Regurgitation or vomiting
• Bloody vomit
• Weight loss or poor weight gain
• Frequent respiratory problems
• Coughing or wheezing
• Hoarseness
• Arching back while feeding
• Irritability or restlessness while feeding

Diagnosis

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 need to be taken of your child's stomach and esophagus. This can be done with:

• Upper GI series
• Upper endoscopy with biopsy
• Nuclear medicine scan

Other tests may include:

• 24-hour pH monitoring—a probe is placed in the esophagus to keep track of the acid in the lower esophagus
• Short trial of medications—success or failure of medication may help your doctor understand the cause

Treatment

There are 3 goals for treatment. The first is to prevent injury to the esophagus. The second is to make sure your child is eating enough. The third goal is to keep the backed up food and acid from getting into the lungs. This will require a team approach. Your child may work with the pediatrician, specialized doctors, and a variety of therapists.

Talk with the doctor about the best treatment plan for your child. Treatment options include:

Prevention

There are no current guidelines to prevent GERD.