Pronounced: Gas-tro-ee-sof-a-geal re-flux disease
Definition
Gastroesophageal 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 this within 12 months. If symptoms do not improve by 18 to 24 months, your infant may have GERD.
GERD can cause serious health issues. The sooner it is treated, the better the outcome.
Gastroesophageal Reflux Disease
Food and acid back up into the esophagus from the stomach.
2008 Nucleus Medical Art, Inc.
Causes
The cause of GERD in infants is unknown. Several factors contribute to GERD including:
- Abnormal pressure to the lower esophageal sphincter (LES), a valve that keeps food in the stomach
- Narrow or short esophagus
- Possibly a genetic link
- Delayed emptying of the stomach (although studies have shown that this may not cause GERD in infants)
Risk Factors
The following factors increase your infant's chance of developing GERD. If your infant has any of these risk factors, tell the doctor:
- Premature birth
- Down syndrome or mental retardation
- Cerebral palsy
- Head injury
- Hiatal hernia
- Food allergies
- Obesity
- Certain medications (eg, theophylline, dexamethasone)
- Exposure to tobacco smoke
Symptoms
If your baby experiences any of these symptoms, do not assume it is due to GERD. Remember GER is very common in the first year of life. If GER symptoms worsen or dont improve by 18 months, ask the doctor to re-evaluate your infant.
These symptoms may be caused by other conditions. If your infant has any of these, tell the doctor:VomitingFailure to thriveRefusal to feed or difficulty feedingIrritability or fussiness after feedingArching of back during or after feedingRegurgitation or bloody vomit Breathing problemsDifficulty swallowingRecurrent pneumonia or respiratory problemsApnea or blue spells (called cyanosis), when not enough blood gets to the lungsCough or wheezingHoarsenessDisturbed sleepExcessive crying DiagnosisYour doctor will ask about your babys symptoms and medical history, and perform a physical exam. Your baby 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 doctor may suggest these lifestyle changes:
Try a hypoallergenic formula for one to two weeks.Provide small, frequent feedingsThicken your babys formula or milk with rice or cereal.Use a different pre-thickened formula.Burp your infant more frequently (eg, every one to two hours after being fed).Make sure your infant is in an upright position for 30 minutes after being fed. Keep a diary of your infant's symptoms.Try certain positions when sleeping. These positions depend on your infant's age because of the risk of sudden infant death syndrome. MedicationsIn most cases, treatment starts with making lifestyle changes. If your infant's GERD doesn't improve, the doctor may recommend medication, such as:Histamine-2 receptor drugsto decrease acid production (eg, Pepcid, Axid, Zantac)Proton pump inhibitorsto heal the esophagus lining and relieve symptoms (eg, Prilosec, Prevacid, Protonix, Nexium) SurgeryIn 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. PreventionWhile the cause of GERD is largely unknown, you can take steps to control the condition in your infant by:
Following the lifestyle and dietary changesAvoiding second-hand smokeKeeping a diary of your infant's symptoms RESOURCES: Childrens Digestive Health and Nutrition Foundationhttp://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: Gastroesophageal reflux disease (GERD) in infants. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Accessed May 19, 2008. Gastroesophageal reflux in infants. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gerdinfant/index.htm. 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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