Gastroesophageal Reflux Disease Adolescent

Definition

Gastroesophageal reflux disease (GERD) is a disorder that results in food and stomach acid backing up into the esophagus from the stomach. GERD requires treatment to avoid complications like esophageal damage.

Gastroesophageal Reflux Disease

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Causes

The lower esophageal sphincter (LES) is a muscular ring between the esophagus and the stomach. It relaxes to let food pass into the stomach, then closes shut to prevent it from backing up. With GERD, the ring does not close as tightly as it normally should. This causes acid reflux, a burning sensation that can be felt below the breastbone.

The following factors contribute to GERD:

• Problems with the nerves that control the LES
• Problems with LES muscle tone
• Impaired peristalsis—muscular contractions that propel food toward the stomach
• Abnormal pressure on the LES
• Increased relaxation of the LES
• Increased pressure within the abdomen

Risk Factors

Factors that may increase your teen's chance of GERD include:

• Obesity
• Smoking
• Alcohol use
• History of a hernia
• Neurological impairments

Symptoms

GERD may cause:

• Chronic heartburn—most common symptom
• Regurgitation
• Abdominal or chest pain
• Vomiting
• Difficulty swallowing
• Dry cough
• Hoarseness
• Sore throat
• Recurrent aspiration pneumonia or worsening asthma
• Weight loss, lack of appetite

Diagnosis

Your doctor will ask about your teen’s symptoms and medical history. A physical exam will be done.

Tests may include:

• 24-hour pH monitoring—a probe is placed in the esophagus to keep track of the acid in the lower esophagus
• Short trial of medications—success or failure of medication may help your doctor understand the cause

Imaging tests can assess LES function and surrounding structures. These may include:

• Upper GI series—x-rays using contrast material that is swallowed
• Upper endoscopy with biopsy

Treatment

Treatment options vary based on the severity of the GERD. Options may include one or more of the following:

Lifestyle Changes

This may be all that is needed to relieve GERD symptoms. In some cases, these may be recommended before medication is prescribed. These changes can be tailored to an individual person based on their habits. Lifestyle changes include:

• Eating smaller, more frequent meals.
• Avoiding overeating.
• Avoiding late night meals.
• Sleeping with the head of the bed elevated.
• Avoiding lying down within 2-3 hours after eating.
• Wearing looser clothing that doesn't bind the stomach area.
• Losing weight if needed.
• Quitting smoking.

Foods and drinks to avoid may include:

• Chocolate
• Fried foods
• Peppermint
• Spicy foods
• Caffeine products
• Carbonated drinks
• Foods high in fat and acid
• Alcohol

Medications

Medication may be needed to relieve symptoms and heal any damage to the esophagus. Many medications for GERD are available over-the-counter and by prescription. Your teen's doctor may recommend the following:

• Antacids
• H-2 blockers
• Proton pump inhibitors

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 LES. This makes the LES stronger and prevents stomach acid from backing up into the esophagus.

Prevention

There are no current guidelines to prevent GERD.