Overview

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 should. This lets the acid flow back into the esophagus. Specific problems that may cause GERD include:

  • 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

Conditions that cause disabilities and their treatment may lead to or worsen reflux.

Risk Factors

Things that may raise a child's chance of GERD include:

  • Birth defects
  • Neurological impairment
  • Premature birth
  • Down syndrome or intellectual disability
  • Cerebral palsy
  • Head injury
  • Hialeah hernia
  • Food allergies
  • Obesity
  • Some medicines
  • Being around tobacco smoke
  • Narrow or short esophagus
  • Delayed emptying of the stomach

SymptomsandDiagnosis

Symptoms

GERD is not the same as reflux. Reflux, or spitting up, is common in infants. Most will outgrow reflux within 12 months.

Children with GERD may have:

  • Chronic pain in chest and throat (heartburn)—most common symptom
  • Problems swallowing or choking with feedings
  • Breathing trouble during sleep
  • Not wanting to eat or being restless or irritable while feeding
  • More mouth secretions
  • Regurgitation, vomiting, or ruminating—bringing up and re-chewing food that was already swallowed
  • Bloody vomit
  • Weight loss or poor weight gain
  • Frequent respiratory problems
  • Coughing, wheezing, or hoarseness
  • Arching back while feeding

It may not be easy to see signs of GERD if the child can not talk.

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. A specialist may need to be seen. This type of doctor focuses on diseases of the stomach and intestines.

Images may need to be taken of the stomach and esophagus. This can be done with:

  • Upper GI series
  • Upper endoscopy with biopsy
  • Nuclear medicine scan

Other tests may help to find cause or guide treatment. 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 medicines—medicines can treat different causes of GERD. If a medicine works or does not work it can help the doctor understand the cause

Treatments

Treatment

There are three goals for treatment. The first is to prevent injury to the esophagus. The second is to make sure the child is eating enough. The third goal is to keep the backed up food and acid from getting into the lungs.

Some things that may help with GERD include:

  • Having kids eat smaller meals more often during the day
  • Having children sit up if possible during meals or feedings
  • Having kids stay sitting up for at least 30 minutes after meals if possible
  • Not eating within 2 to 3 hours before bedtime

    • Every child is different. Ask the doctor if these steps would be helpful and learn about the best treatment plan. Options include:

    Medicines

    Medicines can help decrease acid in the stomach and help the esophagus heal. Options may include:

    • H-2 blockers
    • Proton pump inhibitors

    Many of these are over-the-counter medications that are available in liquid or powder form.

    Procedures

    Surgery or endoscopy may be advised if the GERD is more severe.

    The most common surgery is called quadruplication. Part of the stomach is wrapped around the stomach valve to make it stronger. It should prevent stomach acid from backing up into the esophagus. This surgery is often done through small incisions in the skin.

    Prevention

    GERD cannot be prevented.

    This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

    Edits to original content made by Denver Health.