See also:

• Gastroesophageal Reflux Disease/Heartburn—Overview
• Gastroesophageal Reflux Disease—Adolescent
• Gastroesophageal Reflux Disease—Infant
• Gastroesophageal Reflux Disease—Children with Disabilities

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.

Gastroesophageal Reflux Disease Copyright © Nucleus Medical Media, Inc.

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.

• 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:

• 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
• 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
• 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
• Hoarseness
• Dental problems due to the effect of the stomach acid on the tooth's enamel
• Feeling full almost immediately after eating

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 be needed of your child's stomach and esophagus. A biopsy may be done at the same time. Images can be done with:

• Upper GI series
• Upper endoscopy

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.

Treatment

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

Prevention

There are no current guidelines to prevent GERD.