GERD, Reflux & Related Conditions
At SSM Health Cardinal Glennon Children’s Hospital, we have a nationally recognized pediatric gastroenterology and hepatology program. We can determine if your child has GERD/EoE/milk protein allergy and treat it. The most important thing to know is that with proper treatment, children with GERD can lead normal, active lives.
Infant Reflux
Gastroesophageal reflux (GER) is very common in infants. It is the normal passage of stomach contents back up into the esophagus. It’s typically known as “happy spitters.” Your infant is otherwise healthy, comfortable, and growing well. Some infants do spit up more than others. It often is worse between the ages of 1-4 months and tends to improve after 6 months of age.
GER differs from gastroesophageal reflux disease (GERD), which is reflux associated with troublesome symptoms or complications and may require further treatment. These symptoms in full-term infants include:
- Feeding refusal
- Poor weight gain
- Irritability
- Sleep disturbance
- Respiratory symptoms
GERD in infants also can be associated with coughing, choking, wheezing, or upper respiratory tract symptoms.
Milk Protein Allergy — GERD overlaps and is difficult to distinguish from a cow’s milk protein allergy. The symptoms for a milk protein allergy can include any of the GERD symptoms above as well as bloody stools. Recent guidelines released by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) advise that the first step is to test eliminating dairy from the mother’s diet if breastfeeding, or to try a hypoallergenic formula. Medications such as acid blockers also may improve symptoms in your child but not completely resolve it.
GERD in Children & Adolescents
When your child swallows, a muscle called the lower esophageal sphincter acts like a valve and relaxes so that food can pass from the esophagus to the stomach. The muscle normally stays closed, so that stomach contents don’t flow back into the esophagus. In children and adolescents who have reflux and GERD, however, the lower esophageal sphincter becomes weak or relaxes when it shouldn’t.
There is a muscle (the lower esophageal sphincter) that acts as a valve between the esophagus and stomach. When your child swallows, this muscle relaxes to let food pass from the esophagus to the stomach. This muscle normally stays closed, so the stomach contents don't flow back into the esophagus.
In children/Adolescent who have reflux and GERD, this muscle becomes weak or relaxes when it shouldn't, and the stomach contents flow back into the esophagus.
Common symptoms of GERD in children 1 to 5 years of age include:
- Regurgitation
- Vomiting
- Abdominal pain
- Anorexia
- Feeding refusal (symptoms can lead to an aversion to food)
Older children and adolescents are most likely to resemble adults in their clinical presentation with GERD and to complain of heartburn, epigastric pain, chest pain, nocturnal pain, dysphagia, and sour burps.
Eosinophilic esophagitis (EoE)
Symptoms of GERD can overlap with a condition called eosinophilic esophagitis, a chronic, allergic disease of the esophagus. EoE can make eating and swallowing difficult because of injury or inflammation within the esophagus. Infants and toddlers who have this disease often refuse to eat or drink. Failure to thrive also is an indicator. In older children, they may experience vomiting or recurrent bouts of reflux or abdominal pain in addition to swallowing difficulties. Inflammation can sometimes become so severe that food gets stuck along the digestive tract. If this occurs, call 911 immediately. Treatment for EoE includes identification and avoidance of allergic foods as well as medications and supplemental nutrition products. A minimally invasive procedure called esophageal dilation also may be recommended to expand the narrowed section of the esophagus.
Complications Related to GERD
Barrett’s Esophagus — Severe cases of chronic acid reflux can cause a condition called Barrett’s Esophagus, which causes the esophagus to become red and the lining inside to thicken. It is a warning sign that cell damage in the esophagus is severe, increasing the risk for the development of esophageal cancer.
Esophageal stricture — This condition is a narrowing of the esophagus that can cause difficulty in swallowing. It can be congenital (present at birth) or caused by damage because of GERD or the swallowing of caustic substances such as batteries and household cleaners.
Call your doctor if your child develops these symptoms:
- Bilious (green) or bloody (red or coffee ground) color vomiting
- Consistently forceful vomiting
- Abdominal distention
- Weight loss
- Vomiting associated neurological symptoms as headaches, weakness, vision problems
Children who have the following conditions are at higher risk for developing GERD:
- Obesity
- Neurological impairments, such as cerebral palsy
- Severe developmental delays
- Genetic disorders
- Hiatal hernia
- Esophageal atresia
In most cases, a doctor diagnoses reflux by reviewing your child's symptoms and medical history. If the symptoms do not get better with lifestyle changes and anti-reflux medicines, your child may need testing to check for GERD or other problems.
Several tests can help a doctor diagnose GERD, such as:
- Upper gastrointestinal (GI) endoscopy and biopsy, which uses an endoscope, a long, flexible tube with a light and camera at the end of it. The doctor runs the endoscope down your child's esophagus, stomach, and first part of the small intestine. While looking at the pictures from the endoscope, the doctor may also take tissue samples (biopsy).
- Upper GI series, which looks at the shape of your child's upper GI (gastrointestinal) tract. You child will drink a contrast liquid called barium. For young children, the barium is mixed in with a bottle or other food. The health care professional will take several x-rays of your child to track the barium as it goes through the esophagus and stomach and initial part of small bowel.
- Esophageal pH and impedance monitoring, which measures the amount of acid or liquid in your child's esophagus. A doctor or nurse places a thin flexible tube through your child's nose into the stomach. The end of the tube in the esophagus measures when and how much acid comes back up into the esophagus. The other end of the tube attaches to a monitor that records the measurements. Your child will wear the tube for 24 hours. He or she may need to stay in the hospital during the test.
Sometimes reflux and GERD in children can be treated with lifestyle changes:
- Lose weight, if needed, ask your doctor
- Eat smaller, more frequent meals
- Avoid eating or drinking 2-3 hours before bedtime
- Avoid large meals before stressful periods as exercise and exams
- Avoid caffeine, carbonated beverages, fatty meals, acidic and spicy food
- Avoid smoking and alcohol
- Wear loose-fitting clothing around the abdomen
What other treatments are available?
If changes at home do not help enough, your doctor may recommend medicines to treat GERD. The medicines work by lowering the amount of acid in your child's stomach. Some are over-the-counter medications, while others are prescription medicines.
- Over-the-counter antacids
- H2 blockers, which decrease acid production
- Proton pump inhibitors (PPIs), which lower the amount of acid the stomach makes
- Prokinetics, which help the stomach empty faster
If these don't help and your child still has severe symptoms, then surgery might be an option.