Gastroesophageal Reflux Disease Adolescent

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 shuts to prevent it from backing up. With GERD, the ring does not close as tightly as it should. This causes acid reflux, a burning feeling that can be felt below the breastbone.

The following things contribute to GERD:

• Problems with the nerves that control the LES
• Problems with LES muscle tone
• Problems with the muscle contractions that move food toward the stomach
• Abnormal pressure on the LES
• Increased relaxation of the LES
• Increased pressure within the belly

Risk Factors

Things that may raise the risk of having GERD include:

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

Symptoms

GERD may cause:

• Lasting heartburn—this is the most common symptom
• Vomiting or regurgitation
• Belly or chest pain
• Trouble swallowing
• Dry cough or sore throat
• Hoarseness
• Recurrent aspiration pneumonia or asthma that gets worse
• Weight loss, lack of appetite

Diagnosis

The doctor will ask about symptoms and health history. A physical exam will be done.

Tests may include:

• 24-hour pH monitoring—a probe is put in the esophagus to keep track of the acid in the lower esophagus
• Short trial of medicine—if a medicine works or does not work it may help the doctor understand the cause of a person's GERD

Imaging tests can look at how the LES and the structures around it are working. These may include:

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

Treatment

The goal of treatment is to repair any problems so the LES works properly. How this is done will vary based on how bad the GERD is. Options may include one or more of the following:

Lifestyle Changes

This may be all that is needed to ease GERD symptoms. These may be advised before a person is given medicine. These changes can be tailored based on a person's habits. Lifestyle changes include:

• Eating smaller meals more often.
• Avoiding overeating.
• Avoiding late night meals.
• Sleeping with the head of the bed raised.
• Avoiding lying down within 2 to 3 hours after eating.
• Wearing looser clothing that does not 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

Medicines

Medicine may be needed to ease symptoms and heal any damage to the esophagus. Many GERD medicines are available over the counter and by prescription. The doctor may advise:

• Antacids
• H2 blockers
• Proton pump inhibitors

Procedures

When GERD is more severe the doctor may advise surgery or endoscopy.

The most common surgery is called fundoplication. The surgeon wraps part of the stomach around the LES. This makes the LES stronger and stops stomach acid from backing up into the esophagus.

Prevention

GERD cannot always be prevented.