Gastroesophageal Reflux Disease in Children with Disabilities

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 doesn't 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 child’s chance of GERD include:

• Birth defects
• Neurological impairment
• Premature birth
• Down syndrome or intellectual disability
• Cerebral palsy
• Head injury
• Hiatal hernia
• Food allergies
• Obesity
• Certain medications
• Exposure to tobacco smoke
• Narrow or short esophagus
• Delayed emptying of the stomach

Symptoms

GERD may cause:

• Chronic heartburn—most common symptom
• Difficulty swallowing or choking with feedings
• Impaired breathing during sleep
• Refusal to eat
• Increased mouth secretions
• Regurgitation or vomiting
• Bloody vomit
• Weight loss or poor weight gain
• Frequent respiratory problems
• Coughing or wheezing
• Hoarseness
• Arching back while feeding
• Irritability or restlessness while feeding

Diagnosis

You will be asked about your child's symptoms and medical history. A physical exam will be done. Your child may need to see a pediatric gastroenterologist. This type of doctor focuses on diseases of the stomach and intestines.

Images may need to be taken of your child's stomach and esophagus. This can be done with:

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

Other 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

Treatment

There are 3 goals for treatment. The first is to prevent injury to the esophagus. The second is to make sure your child is eating enough. The third goal is to keep the backed up food and acid from getting into the lungs. This will require a team approach. Your child may work with the pediatrician, specialized doctors, and a variety of therapists.

Talk with the doctor about the best treatment plan for your child. Treatment options include:

Medications

Most GERD in children can be relieved with lifestyle changes. Medication may be given if your child's GERD doesn't improve. Medications can help to decrease acid in the stomach and help the esophagus heal. Medication 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 recommended with more severe cases.

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

Prevention

There are no current guidelines to prevent GERD.