Pronounced: Gas-tro-ee-sof-a-geal re-flux diseaseby Patricia Griffin Kellicker, BSN DefinitionGastroesophageal reflux disease (GERD) is a disorder that results from food and stomach acid backing up into the esophagus from the stomach. GERD is different from gastroesophageal reflux (GER). GER is a common disorder seen in infants, which causes them to spit up. Most infants outgrow GER within 12 months.GERD can occur at any age and typically requires lifestyle changes, medications, and sometimes surgery. GERD can cause serious health issues and the sooner it is treated, the better the outcome. Gastroesophageal Reflux Disease 2008 Nucleus Medical Art, Inc. CausesThe exact cause of GERD is unknown. Several factors contribute to the condition, including:Abnormal pressure to the lower esophageal sphincter (LES), a valve that keeps food in the stomachNarrow or short esophagusDelayed emptying of the stomach Risk FactorsThe following factors increase the chances of developing GERD. If your child has any of these risk factors, tell the doctor:Premature birthDown syndrome or mental retardationCerebral palsyHead injuryHiatal herniaFood allergiesObesityCertain medications (eg, theophylline, dexamethasone)Exposure to tobacco smoke SymptomsIf your child has any of these symptoms do not assume it is due to GERD. These symptoms may be caused by other conditions. Tell the doctor if your child has any of these:
Regurgitation or vomiting Bloody vomitWeight loss or poor weight gainDifficulty swallowingPain in the abdomen or chestRecurrent pneumonia or respiratory problemsCough or wheezingHoarsenessAnemiaDental problems (due to the effect of the stomach acid on the tooth's enamel)Feeling full almost immediately after eatingIrritation to esophagusChronic heartburn DiagnosisYour doctor will ask about your childs symptoms and medical history, and perform a physical exam. Your child may need to see a pediatric gastroenterologist, a doctor who specializes in gastrointestinal diseases.Tests may include:Upper GI seriesa series of x-rays of the upper digestive system taken after drinking a barium solutionUpper endoscopy with biopsya tube is inserted into esophagus to look at the lining and a piece of tissue is taken for testing24-hour pH monitoringa probe is placed in the esophagus to keep track of the level of acidity in the lower esophagusShort trial of medicine TreatmentTalk with your doctor about the best treatment plan for your child. Treatment options include the following: Lifestyle ChangesYour child's doctor may suggest making lifestyle changes before trying medication. These changes may include: Eating small, frequent mealsNot eating two to three hours before bedtimeRaising the head of your childs bedInstructing your child to lie on the left side when sleepingYour child may also need to avoid certain foods, such as:
- Chocolate
- Fried foods
- Peppermint
- Spicy foods
- Caffeine products
- Carbonated beverages
- Foods high in fat and acid
If your child is obese, your doctor may recommend weight loss. Avoiding second-hand smoke is also important.
Medications
Medications may include:
- Histamine-2 receptor drugsto decrease acid production (eg, Tagamet, Pepcid, Zantac)
- Proton pump inhibitorsto heal the esophagus lining and relieve symptoms (eg, Prilosec, Prevacid, Protonix, Nexium)
- Promotility drugsto help slow stomach emptying (eg, Reglan)
- Over-the-counter antacidsto treat heartburn relief (eg, Tums, Maalox)
Many of these are over-the-counter medications. Talk to your child's doctor about any new medication.
Surgery
In severe cases, the doctor may recommend surgery. The most common treatment is called fundoplication. During this procedure, the surgeon wraps part of the stomach around the lower esophageal sphincter. This makes the sphincter stronger and prevents stomach acid from backing up into the esophagus.
Prevention
While most causes of GERD in children are unknown, there are some steps to control the condition. For example, you can help your child:
- Stick to lifestyle and dietary changes
- Keep a food diary and record the symptoms
- Avoid second-hand smoke
RESOURCES:
Childrens Digestive Health and Nutrition Foundation
http://cdhnf.org/ National Digestive Diseases Information Clearinghouse (NDDIC)http://digestive.niddk.nih.gov/index.htm CANADIAN RESOURCES: About Kids Healthhttp://www.aboutkidshealth.ca Canadian Digestive Health Foundationhttp://www.cdhf.ca/index.html References: Dente K. Quick lesson about gastroesophageal reflux disease in children and adolescents. EBSCO Nursing Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16topicID=860. Accessed May 19, 2008. Gastroesophageal reflux in children and adolescents. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gerinchildren/index.htm. Accessed May 19, 2008. GERD in children and adolescents. Childrens Digestive Health and Nutrition Foundation website. Available at: http://gerd.cdhnf.org/User/Docs/PDF/AdolesGERDFlier.pdf. Accessed May 19, 2008. GERD in children with an underlying structural anomaly. Childrens Digestive Health and Nutrition Foundation website. Available at: http://gerd.cdhnf.org/User/Docs/PDF/CUSA_Brochure.pdf. Accessed May 19, 2008. Pediatric gastroesophageal reflux, clinical practice guideline summary. Childrens Digestive Health and Nutrition Foundation website. Available at: http://gerd.cdhnf.org/User/Docs/PDF/GERD_8_pg_brochure_031604.pdf. Accessed May 19, 2008.
Pediatric GE reflux clinical practice guidelines. J Pediatr Gastroenterol Nutr. 2001;32:S1-S31. Last reviewed May 2008 by Kari Kassir, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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