• Gastroesophageal Reflux Disease—Child

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

    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 your mouth and stomach. GER is common in infants. It causes them to spit up. Most infants outgrow GER within 12 months.
    GER that continues to happen 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 can occur at any age. It most often requires lifestyle changes. Some more serious GERD may need medication or surgery. With any GERD, the sooner it is treated, the better the outcome.
    Gastroesophageal Reflux Disease
    si1347 97870 1 gerd
    Copyright © Nucleus Medical Media, Inc.

    Causes

    GERD is caused by stomach acid that regularly backs up into the esophagus. It is not always clear why the acid backs up. The reasons may vary from person to person. There may also be a genetic link in some GERD.
    Acid is kept in the stomach by a valve at the top of the stomach. The valve opens when food comes in. It should close to keep in the food and acid. If this valve does not close properly, the acid can flow out of the stomach. The valve may not close because of:
    • Problems with the nerves that make the valve open or close
    • Increased pressure in the stomach
    • Irritation in the stomach or muscles of the valve
    • Problem with the valve itself

    Risk Factors

    The following factors increase the chances of developing GERD. If your child has any of these risk factors, tell the doctor:

    Symptoms

    If 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 vomit
    • Weight loss or poor weight gain
    • Difficulty swallowing
    • Pain in the abdomen or chest
    • Recurrent pneumonia or 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
    • Chronic heartburn

    Diagnosis

    Your doctor will ask 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.
    Tests may include:
    • Upper GI series —a series of x-rays of the stomach and esophagus
    • Upper endoscopy with biopsy—a tube is inserted into esophagus to look at the lining and take a piece of tissue for testing
    • 24-hour pH monitoring—a probe is placed in the esophagus to measure the level of acid
    • Short trial of medicine—the doctor may use the success or failure of a medication to understand the cause

    Treatment

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

    Lifestyle Changes

      Your child's doctor may suggest making lifestyle changes before trying medication. These changes may include:
      • Eating small, frequent meals
      • Avoid eating 2-3 hours before bedtime
      • Raising the head of your child’s bed
      • Have your child lie on their left side when sleeping
      Your child may 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.
    • Avoid second-hand smoke exposure in your child.

    Medications

    Medications options include:
    • Histamine-2 receptor drugs—to decrease acid production and promote healing (eg, Tagamet , Pepcid , Zantac )
    • Proton pump inhibitors—also decreases acid production and promote healing (eg, Prilosec , Prevacid , Protonix , Nexium )
    • Promotility drugs—to help stomach emptying (eg, metoclopramide [Reglan]), not used often
    Many of these are over-the-counter medications. Talk to your child's doctor about any new medication.

    Procedures

    Surgery or endoscopy may be recommended for more severe cases. It may be considered if lifestyle changes and medications do not work.
    The most common surgery is called fundoplication . During this procedure, a part of the stomach will be wrapped around the stomach valve. This makes the valve stronger. It should prevent stomach acid from backing up into the esophagus. This surgery is often done through small incisions in the skin, called laparoscopy .

    Prevention

    Most causes of GERD in children are unknown. Some cases of GERD may be prevented by:
    • Following recommended lifestyle and dietary changes if your child had GER
    • Avoiding second-hand smoke

    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 July 27, 2012.

    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 July 27, 2012.

    Gastroesophageal reflux disease (GERD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated July 2012. Accessed July 30, 2012.

    GERD in children and adolescents. Children’s Digestive Health and Nutrition Foundation website. Available at: http://www.gastrokids.org/content/8/en/Reflux-GERD . Accessed July 27, 2012.

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

    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 July 27, 2012.

    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.

    Revision Information

    • Reviewer: Michael Woods
    • Review Date: 09/2012
    • Update Date: 00/92/2012
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