GERD At A Glance

WHAT IS REFLUX AND GERD?

The term reflux is a shorter way of referring to GER (Gastro Esophageal Reflux) and is simply defined as the backward flow of stomach contents up the esophagus.  GER is a physiological* process that happens to everyone—young and old—from time to time, particularly after meals and many times we are not even aware it is happening.

When a baby or child (or anyone for that matter) is referred to as having GER, the term represents a benign condition in which the child is having frequent "reflux" episodes.  This is also called "Functional GER" and does not cause complications, lead to long term problems, affect growth or development or even necessarily require medical intervention.  The category of GER can range from reflux material simply entering the distal (bottom of the) esophagus to spitting up and even frequent projectile vomiting.  Projectile vomiting alone is not considered to be a complication and as long as no other complications arise, it is considered GER.

GER (Gastro Esophageal Reflux) is referred to as GERD (Gastro Esophageal Reflux Disease) when complications arise.  GERD is a pathological** process and the complications can be typical (failure to thrive, feeding and oral aversions, esophagitis, etc) or atypical (wheezing, pneumonia, chronic sinusitis, etc).  Patients with GERD have complications arising from their GER that necessitate medical intervention.  GERD is also referred to as "Pathogenic GER".  It is estimated that approximately one in three hundred children will present symptoms of GERD and is more common in children with neurological impairments.

HOW DO I KNOW IF MY BABY HAS REFLUX OR GERD?

Some symptoms of reflux or GERD include:

• constant or sudden crying or colic like symptoms
• irritability and pain
• poor sleep habits typically with frequent waking
• arching their necks and back during or after eating
• spitting-up or vomiting
• wet burp or frequent hiccups
• frequent ear infections or sinus congestion
• refusing food or accepting only a few bites despite being hungry or the exact opposite requiring constant small meals or liquid
• food/oral aversions
• anemia
• excessive drooling
• running nose, sinus infections
• swallowing problems, gagging, choking
• chronic hoarse voice
• frequent red, sore throat without infection present
• apnea
• chronic ear infections
• respiratory problems—pneumonia, bronchitis, wheezing, asthma, night-time cough, aspiration
• gagging themselves with their fingers or fist (sign of esophagitis)
• poor weight gain, weight loss, failure to thrive
• erosion of dental enamel
• neck arching (Sandifer's Syndrome)
• bad breath

WILL THE DOCTOR DO TESTS?

Much of the time reflux is diagnosed purely from parental reports of the child's symptoms.  Many times this information is more than sufficient in determining whether or not the child is refluxing and no further testing is required.  In cases where more information is needed the following are some of the tests that may be conducted to diagnose reflux, as well as other digestive conditions or problems.

Barium Swallow (aka Upper GI)

The child is made to swallow a small amount of barium (white, chalky liquid), the doctor watches a series of fluoroscopic x-rays over approximately fifteen to twenty minutes.  The barium highlights or outlines the esophagus, throat and upper intestines allowing the doctor to view the food as it travels down the esophagus, into the stomach and into the first part of the small intestines (duodenum).  Typically the first test done to diagnose reflux it's not always the most reliable, negative results are common with children who actually have reflux.  This is because the child has to actually reflux during the test to provide a positive result.  This test is more valuable at determining anatomic abnormalities within the digestive system.

Reflux Scan

Similar to the Upper GI.  The child swallows a small amount of a radioactive solution, is laid flat on a table which has an x-ray under it.  The x-ray takes constant pictures for one hour to measure the frequency of reflux episodes over the hour.

Upper Endoscopy (aka Scope)

This test reveals the extent of damage caused by reflux. A flexible tube (endoscope) with lights and a camera is passed down the child's mouth into the esophagus, stomach and first part of the small bowel (duodenum) to see if any damage is present. The doctor may take biopsies at this time which involves removing small pieces of tissue from each location.

pH Monitoring

A thin tube is inserted through the nose and down the esophagus.  This will stay in place for twenty four hours.  While the child goes about normal activities it measures the amount of acid that reaches the esophagus and the frequency with which it occurs. The procedure can help detect whether respiratory symptoms, such as wheezing and coughing, are triggered by reflux.

HOW IS INFANT REFLUX AND GERD TREATED?

Lifestyle adjustments are the first defense against reflux or GERD.  There are simple things you can do to help diminish reflux episodes without even seeing a doctor.  The first thing to start doing is provide smaller, but more frequent feedings through the day. It may seem like you are then spending all your time feeding the baby, but it will pay off in the long run as you will likely spend less time trying to console a screaming or puking baby.  Next, keep baby propped up during a feeding, for at least a half hour after feeding and while sleeping.  Avoid putting clothes on the baby that are tight or constrictive in the belly region and *thicken formula with small amounts of cereal.  More lifestyle adjustments can be found here »

Medications are next in line if lifestyle modifications aren't enough.

1. ANTACIDS:  These neutralize acid in the stomach. Antacids do not decrease acid production, rather work by temporarily neutralizing the acid that is in the stomach at the time they are taken.  They work quickly but do not have long lasting effects.
2. CYTOPROTECTIVE AGENTS:  These are used to help line and protect delicate tissues in the esophagus.
3. H2 RECEPTOR ANTAGONISTS: Also called H2 Blockers, this class of drug works by blocking acid production.
4. PROTON PUMP INHIBITORS: PPI's are the most effective medication used to control reflux. They almost completely shut down the acid pumps in the stomach.
5. MOTILITY AGENTS: These medications are used to move food through the digestive tract faster.

Surgical treatment for GERD is by no means a cure for GERD and is only performed when severe symptoms and complications persist. Also referred to as the 'wrap' or 'fundo', a surgery called the nissen fundoplication is the final option for controlling very severe GERD. Because of the possible complications that can accompany this surgery, it is typically done as a last resort.  It involves wrapping the upper portion of the stomach (fundus) around the lower portion of the esophagus. There are different types of fundos performed: the Nissen fundoplication refers to wrapping the fundus all the way (360°) around the esophagus.  As well, partial wraps can be performed.  A 180° wrap is known as a Thal or Toupet fundo and a 90° wrap is known as an anterior partial wrap.