Acid Reflux (Gastroesophageal Reflux)

What is acid reflux / gastroesophageal reflux disease?

Gastroesophageal reflux disease (GERD) occurs when acid and food in the stomach back up into the esophagus.

What causes GERD?

GERD often occurs when the lower muscle (sphincter) of the esophagus does not close properly. The sphincter normally opens to let food into the stomach. It then closes to keep food and stomach acid in the stomach. If the sphincter does not close properly, stomach acid and food back up (reflux) into the esophagus.

What are the signs and symptoms of GERD?

Heartburn is the most common symptom of GERD. You may feel burning pain in your chest or below the breast bone. This usually occurs after meals and spreads to your neck, jaw, or shoulder. You may also have any of the following:

• Bitter or acid taste in your mouth.
• Coughing, choking, or shortness of breath.
• Trouble or difficulty swallowing.
• Frequent burping or hiccups.
• Vomiting blood or having black, tarry bowel movements.
• Weight loss without trying.

What are the signs and symptoms of GERD in children?

Your child may have no symptoms. If your child has symptoms, he or she may have one or more of the following:

• Breathing problems: Your child may wheeze (make a high-pitched noise) or make a loud, rough noise when he or she breathes. Some children, mostly infants, may have periods where they stop breathing. This is called an apparent life-threatening event (ALTE). Ask your child’s healthcare provider for more information about ALTEs.
• Cough and voice changes: GERD may cause your child to cough often. Your child’s voice may also change or sound hoarse when he or she has GERD.
• Heartburn: Heartburn is when your child has a painful, burning feeling in his or her chest. Heartburn often occurs after eating. The burning feeling comes from stomach contents or acid that backs up into his or her esophagus. Your child may have abdominal pain and trouble sleeping. Your child may also belch often or get the hiccups.
• Irritability: Your child may become fussy and cry often. He or she may begin crying for no known reason and be hard to calm.
• Poor feeding and growth: With GERD, your child may not eat the right amounts of food to help him or her grow. Your child may be shorter or weigh less than other children his or her age. Infants with GERD may arch their back when they are fed.
• Swallowing problems: Your child may have problems swallowing food and liquids. He or she may feel like there is a lump in his or her throat. Your child may also feel pain when he or she swallows.
• Regurgitation or vomiting: Regurgitation is the backing up of stomach contents into your child’s throat or mouth. Vomiting more commonly occurs in infants. He or she may vomit without feeling sick first. When your child vomits often, you may see blood in his or her vomit.

What are the risks for developing GERD?

The following may increase your risk:

• Certain foods that contain caffeine, chocolate, peppermint, and fried or fatty foods.
• Hiatal hernia.
• Medicines, such as nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, or some antibiotics.
• Weight gain or pregnancy.
• Lying down after a meal.
• Cigarettes or alcohol.

The following may also increase your child’s risk for GERD:

• Premature infants: Infants born earlier than expected may have an increased risk for swallowing problems and GERD. Infants often outgrow GERD by the time they are 12 months old.
• Neurological disorders: Conditions such as cerebral palsy increase your child’s risk for GERD. Ask your child’s healthcare provider for more information about what conditions may lead to GERD.
• Asthma: Children who have asthma have a higher risk for GERD.
• Specific foods: GERD may also occur if your child has an allergy to cow’s milk or other foods. Drinks with caffeine may increase your child’s risk for GERD.
• Smoking: Being around people who smoke often may lead to GERD.

How is GERD prevented?

• Do not have foods or drinks that may increase heartburn. These include chocolate, peppermint, fried or fatty foods, and drinks that contain caffeine. Do not have foods or drinks that can irritate your esophagus, such as citrus fruits, juices, and alcohol.
• Do not eat large meals. When you eat a lot of food at one time, your stomach needs more acid to digest it. Eat six small meals each day instead of three large ones, and eat slowly. Do not eat meals two to three hours before bedtime.
• Elevate the head of your bed. Place six-inch blocks under the head of your bed frame. You may also use more than one pillow under your head and shoulders while you sleep.
• Maintain a healthy weight. If you are overweight, weight loss may help relieve symptoms of GERD.
• Do not smoke. If you smoke, it is never too late to quit. Smoking weakens the lower esophageal sphincter. Ask  your provider for information if you need help quitting.

How is GERD diagnosed?

Your healthcare provider will ask about your symptoms and when they started. Tell him or her about other medical conditions you have, your eating habits, and your activities. You may also need any of the following:

• Esophageal pH monitoring: This is used to place a small probe inside your esophagus and stomach to check the amount of acid.
• An endoscopy: This procedure is used to look at the inside of your esophagus and stomach. An endoscope is a bendable tube with a light and camera on the end. Your healthcare provider may remove a small sample of tissue and send it to a lab for tests.
• Upper GI X-rays: These X-rays are done to take pictures of your stomach and intestines (bowel). You may be given a chalky liquid to drink before the pictures are taken. This liquid helps your stomach and intestines show up better on the X-rays.
• Esophageal manometry: This test shows how your esophagus pushes food and fluid to your stomach. It also shows the pressures in your esophagus and stomach. It may show a hiatal hernia.

How is GERD treated?

• Medicines are used to decrease stomach acid. Medicine may also be used to help your lower esophageal sphincter and stomach contract (tighten) more.
• Surgery is done to wrap the upper part of the stomach around the esophageal sphincter. This will strengthen the sphincter and prevent reflux.

How is gastroesophageal reflux in children diagnosed?

Your child’s healthcare provider will do a physical exam. He or she will ask about your child’s symptoms and when they started. Tell your child’s healthcare provider about your child’s medical conditions, eating habits, and activities. Your child’s healthcare provider may ask about any family history of GER and if any stressful events have happened lately. If your child has been vomiting, tell his healthcare provider how often and how much he or she vomits and if he or she feels pain. Also tell your child’s healthcare provider if you have noticed blood in your child’s vomit.

Your child’s healthcare provider may do any of the following tests:

• Upper gastrointestinal X-rays: During an upper gastrointestinal (GI) X-ray, pictures are taken of your child’s upper GI tract. The upper GI tract includes the esophagus, stomach and intestines (bowel). Your child may be given a chalky liquid to drink before the pictures are taken. This liquid helps your child’s stomach and intestines show up better on the X-rays. This test may show if upper GI problems are causing your child’s GERD.
• Nuclear scintigraphy: During nuclear scintigraphy, a machine is used to take pictures of your child’s stomach and esophagus. Your child will be asked to swallow food or a formula that has radioactive liquid in it. This test may show how well his or her stomach empties and if he or she has reflux. Your child’s healthcare provider may also check if your child is aspirating. Aspirating occurs when liquid or food goes into your child’s lungs.
• Endoscopy: An endoscopy uses an endoscope to see the inside of your child’s digestive tract. An endoscope is a long flexible tube with a light and camera on the end. During an endoscopy, healthcare providers will look for any tissue damage in your child’s esophagus. Healthcare providers will also look for problems with how your child’s digestive tract is working. A biopsy (tissue sample) may be taken from your child’s digestive tract and sent to a lab for tests.
• Esophageal pH monitoring: During esophageal pH monitoring, the pH (acid or base levels) in your child’s esophagus is measured. Sensors are put into your child’s nose and down into his or her esophagus. The sensors will normally be left in place for a day. This test measures how much and how often stomach acid refluxes into your child’s esophagus.

How is GERD treated in children?

The goal of treatment is to relieve your child’s symptoms and prevent damage to his or her esophagus. Treatment is also done to promote healthy weight gain and growth. Your child may need the following:

• Medicine:
  • Histamine type-2 receptor blocker: This group of medicines is also called H2 blockers. They block acid production in your child’s stomach.
  • Proton pump inhibitor (PPI): This medicine blocks acid from forming in your child’s stomach.
  • Antacids: This medicine decreases the stomach acid that can irritate your child’s esophagus and stomach.
  • Prokinetic medicine: Prokinetic medicine decreases the amount of time food stays in your child’s stomach. When your child’s stomach empties properly, he or she may have a decreased risk for reflux.
• Surgery: Surgery may be needed if your child’s GERD does not improve with other treatments. Your child may need surgery to correct a part of his stomach or tighten the lower esophageal sphincter. He or she may also need a tube placed into his or her abdomen to decrease the risk for GERD. Ask your child’s healthcare provider for more information on surgery to help his GERD.

What can I do to help my child with GERD?

• Keep a diary of your child’s symptoms: Write down when your child becomes fussy, cries for no reason, or has trouble sleeping. Write down what your child is doing when symptoms occur. Bring the diary to your child’s visits with his or her healthcare provider. The diary may help your child’s healthcare provider plan the best treatment for him or her.
• Feed your infant thickened or special formula: Thickening your infant’s milk or formula may decrease how often he or she vomits. Rice-cereal can be added to your infant’s feeding to make it thicker. You may also try to feed your child hypoallergenic milk formula to decrease GERD. Smaller feedings more often may also help decrease your infant’s GERD.
• Position your infant after feedings to decrease his or her symptoms: After you feed your infant, keep him or her sitting upright for 90 minutes to decrease GERD. Laying your infant on his or her left side after he or she eats may also help decrease his or her risk for reflux.
• Have your child sleep on his or her left side with his or her head raised: This may decrease his or her reflux while he or she sleeps. The head of your child’s bed can be raised by placing pillows or blocks under his or her mattress.
• Help your child make good food choices: If your child is overweight, his or her risk for GERD increases. Spicy foods, chocolate, and drinks with caffeine should be avoided. Make sure your child knows that staying away from certain foods may help him or her feel better. Talk to your child’s healthcare provider about the best food choices him or her.
• Keep your child away from cigarette smoke: Do not smoke or allow others to smoke around your child. If your child smokes, help him or her to stop. Smoking can worsen your child’s GERD and harm his or her heart, lungs, and blood.

When should I seek immediate care for GERD?

• You feel full and cannot burp or vomit.
• You have severe chest pain and sudden trouble breathing.
• Your bowel movements are black, bloody, or tarry-looking.
• Your vomit looks like coffee grounds or has blood in it.

When should I contact my healthcare provider?

• Your symptoms get worse or do not improve with treatment.
• You have questions or concerns about your condition or care.

When should I seek immediate care or call 911 for my child?

• Your child suddenly stops breathing, begins choking, or his or her body becomes stiff or limp.
• Your child’s skin turns blue or very red.
• Your child suddenly has trouble breathing or makes new noises when he or she breathes.
• Your child vomits more blood than he or she has before, or he or she vomits blood for the first time.
• Your child has severe chest pain.
• Your child has severe stomach pain and swelling.

When should I contact my child’s healthcare provider?

• Your child becomes more irritable or fussy and does not want to eat.
• Your child becomes weak and urinates less than normal.
• Your child is losing weight when he or she should not be.
• Your child has ear pain.
• Your child has more trouble swallowing than he or she has before, or he or she feels new pain when he or she swallows.
• Your infant arches his or her back during feedings.
• You have questions or concerns about your child’s condition or care.