Gastroesophageal Reflux Disease Child

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 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.

• 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 a child's chance of GERD include:

• Premature birth
• Parents with a history of heartburn or acid regurgitation
• Down syndrome or intellectual disability
• Neurological impairments
• Cerebral palsy
• Head injury
• Hiatal hernia
• Food allergies
• Obesity
• Certain medicines
• Being around tobacco smoke
• Narrow or short esophagus
• Delayed emptying of the stomach

Symptoms

GERD may cause:

• Chronic heartburn—most common symptom
• Regurgitation or vomiting
• Green, yellow-green, or bloody vomit
• Weight loss or poor weight gain
• Problems swallowing
• Pain in the belly or chest
• Coughing, wheezing, or other breathing problems
• Hoarseness
• Dental problems due to the stomach acid hurting tooth enamel
• Feeling full almost immediately after eating

Diagnosis

The doctor will ask about symptoms and health history. A physical exam will be done. A pediatric gastroenterologist may need to be seen. This type of doctor focuses on diseases of the stomach and intestines in kids.

Images may be needed of the stomach and esophagus. A biopsy may be done at the same time. Images can be done with:

• Upper GI series
• Upper endoscopy

Other tests may include:

• 24-hour pH monitoring—A probe is put in the esophagus to measure the level of acid.
• Short trial of medicines—Medicines treat different causes of GERD. If 1 medicine works or does not work it can help the doctor figure out what is causing it.

Treatment

The goal of treatment is to prevent harm to the esophagus and get rid of symptoms. How that is done depends on what is causing the GERD. Treatment options include:

Lifestyle Changes

• The doctor may advise making lifestyle changes before trying medicine. These changes may include:
  • Eating small meals more often
  • Not eating 2 to 3 hours before bedtime
  • Raising the head of the child's bed
  • Having the child lie on their left side when sleeping
• Avoiding certain foods and drinks, such as:
  • Chocolate
  • Fried foods
  • Peppermint
  • Spicy foods
  • Thing that have caffeine
  • Carbonated drinks like soda
  • Foods high in fat and acid
• If needed the doctor may give advice on helping a child get to a healthy weight.
• Keeping children away from secondhand smoke.

Medicines

Medicines 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:

• H-2 blockers
• Proton pump inhibitors
• Promotility drugs—to help stomach emptying (not used often)

Procedures

Surgery or endoscopy may be advised when GERD is more severe or lifestyle changes and medicine did not help.

The most common surgery is called fundoplication. A part of the stomach will be wrapped around the stomach valve. This makes the valve stronger. It should stop stomach acid from backing up into the esophagus. This surgery is often done through small incisions in the skin.

Prevention

GERD cannot be prevented.