• Gastroesophageal Reflux Disease—Adolescent

    (GERD—Adolescent; Chronic Heartburn—Adolescent; Reflux Esophagitis—Adolescent; Gastro-oesophageal Reflux Disease—Adolescent; GORD—Adolescent; Heartburn—Adolescent; Reflux—Adolescent)

    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 GER within 12 months.
    GERD can occur at any age and typically requires lifestyle changes, medications, and sometimes surgery. This condition can cause serious health issues. The sooner it is treated, the better the outcome.
    Gastroesophageal Reflux Disease
    si1347 97870 1 gerd
    Copyright © Nucleus Medical Media, Inc.

    Causes

    Food travels down the esophagus to the stomach. The opening between the esophagus and stomach opens to let food enter the stomach. Normally, it closes as soon as the food enters the stomach. With heartburn, the opening does not close tightly. Stomach acid flows into the esophagus (called acid reflux), causing a burning sensation.
    The following factors contribute to GERD:
    • Abnormal pressure to the lower esophageal sphincter (LES), a valve that keeps food in the stomach
    • Increased relaxation of LES
    • Increased pressure within the abdomen
    • Possibly a genetic link
    Other causes include diseases that interfere with food passing through the esophagus or cause excess acid production.

    Risk Factors

    Unlike infants and children, there are not many known risk factors for the development of GERD among adolescents. Obesity , a risk factor for adults, may also increase the risk of developing this condition among teenagers. Smoking and using alcohol may also put teens at risk.

    Symptoms

    If your teen has any of these symptoms, do not assume it is due to GERD. These symptoms may be caused by other conditions. If your child has any of these, tell the doctor:
    • Heartburn
    • Abdominal or chest pain
    • Regurgitation
    • Vomiting
    • Need to clear throat
    • Bloody vomit
    • Bad breath
    • Difficulty swallowing
    • Worsening asthma
    • Recurrent pneumonia or respiratory problems
    • Sore throat
    • Cough, wheezing, or hoarseness
    • Dental problems (due to the effect of the stomach acid on the tooth's enamel)

    Diagnosis

    Your doctor will ask about your teen’s symptoms and medical history, and perform a physical exam. Your child may need to see a gastroenterologist, a doctor who specializes in gastrointestinal diseases.
    Tests may include:
    • Upper GI series —a series of x-rays of the upper digestive system taken after drinking a barium solution
    • Upper endoscopy with biopsy—a tube is inserted into esophagus to look at the lining and a piece of tissue is taken for testing
    • 24-hour pH monitoring—a probe is placed in the esophagus to keep track of the level of acidity in the lower esophagus
    • Short trial of medicine

    Treatment

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

    Lifestyle Changes

    Before recommending medication, your teen's doctor may suggest lifestyle changes. These may include:
    • Eating smaller, more frequent meals
    • Avoiding late night snacks
    • Sleeping on the left side
    • Avoiding certain foods, such as:
      • Chocolate
      • Fried foods
      • Peppermint
      • Spicy foods
      • Caffeine products
      • Carbonated beverages
      • Foods high in fat and acid
    If your teen is obese, your doctor may recommend weight loss. Also, talk to your teen about smoking and alcohol, which can worsen GERD symptoms.

    Medications

    Medications may include:
    • Over-the-counter antacids—to treat heartburn relief (eg, Tums, Maalox Advanced Regular Strength)
    • Histamine-2 receptor drugs—to decrease acid production (eg, cimetidine , famotidine , ranitidine )
    • Proton pump inhibitors—to heal the esophagus lining and relieve symptoms (eg, omeprazole , lansoprazole )
    • Promotility drugs—to help slow stomach emptying (eg, metoclopramide )
    Many of these are over-the-counter medications. Talk to your teen's doctor about any new medication.

    Procedures

    In more severe cases, the doctor may recommend surgery or endoscopy. The most common surgery 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. In many cases, this procedure can be done through small incisions in the skin, called laparoscopy .

    Prevention

    While some of the causes of GERD in adolescents are unknown, your teen can take these steps to control the condition:
    • Following the doctor's dietary and lifestyle changes
    • Avoiding smoking and second-hand smoke
    • Avoiding drinking alcohol
    • Keeping a diary of symptoms

    RESOURCES

    Children’s Digestive Health and Nutrition Foundation http://cdhnf.org/

    National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov/index.htm

    CANADIAN RESOURCES

    About Kids Health http://www.aboutkidshealth.ca

    Canadian Digestive Health Foundation http://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/pointOfCare/nrc-about . Accessed May 19, 2008.

    EsophyX receives FDA clearance for performing transoral incisionless fundoplication surgery. Medical News Today website. Available at: http://www.medicalnewstoday.com/articles/83410.php . Published September 24, 2007. Accessed August 19, 2009.

    Gastroesophageal reflux disease (GERD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . 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. Children’s 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. Children’s Digestive Health and Nutrition Foundation website. Available at: http://gerd.cdhnf.org/User/Docs/PDF/CUSA%5FBrochure.pdf . Accessed May 19, 2008.

    Pediatric gastroesophageal reflux, clinical practice guideline summary. Children’s Digestive Health and Nutrition Foundation website. Available at: http://gerd.cdhnf.org/User/Docs/PDF/GERD%5F8%5Fpg%5Fbrochure%5F031604.pdf . Accessed May 19, 2008.

    Pediatric GE reflux clinical practice guidelines. J Pediatr Gastroenterol Nutr. 2001;32:S1-S31.

    Transoral incisionless fundoplication with EsophyX. Endogastric Solutions website. Available at: http://www.endogastricsolutions.com/esophyx%5Ffor-pt.htm . Accessed August 19, 2009.

    Transoral incisionless fundoplication (TIF) procedure with EsophyX device provides new treatment option for children suffering from chronic GERD. Endogastric Solutions website. Available at: http://www.endogastricsolutions.com/esophyx%5Ffor-pt.htm . Published January 9, 2009. Accessed August 19, 2009.

    Treating GERD. Ohio State University Medical Center website. Available at: http://medicalcenter.osu.edu/patientcare/healthcare%5Fservices/digestive%5Fdisorders/gerd%5Fheartburn/diagnosing%5Ftreating%5Fgerd/treating%5Fgerd/Pages/index.aspx . Accessed August 19, 2009.

    3/1/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Maalox Total Relief and Maalox liquid products: medication use errors. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm200672.htm . Published February 17, 2010. Accessed March 2, 2010.

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