Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention

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Definition

Gastroesophageal reflux (GER) is a back up of acid or food from the stomach to the esophagus. The esophagus is the tube that connects your mouth and stomach. GER is common in babies. It causes them to spit up. Most babies outgrow GER within 12 months.

After 18-24 months, esophageal injury and additional symptoms may point to gastroesophageal reflux disease (GERD). GERD is pain and swelling in the esophagus. It is caused by the regular flow of acid to the esophagus. GERD can cause serious health issues. The sooner it is treated, the better the outcome.

Gastroesophageal Reflux Disease

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Food and acid back up into the esophagus from the stomach.
Copyright © Nucleus Medical Media, Inc.

Causes

GERD is caused by acid or food that regularly backs up into the esophagus. It is not always clear why the acid backs up. The reasons may also vary from person to person. There may be a genetic link in some GERD.

Acid is kept in the stomach by a valve at the top of the stomach. The valve opens when food comes in. It should close to keep in the food and acid. When this valve does not close properly, the acid can flow out of the stomach. In addition to GERD, the valve may not close because of:

  • Problems with the nerves that make the valve open or close
  • Increased pressure in the stomach such as too much food in the stomach or pressure on the abdomen
  • Irritation in the stomach or muscles of the valve
  • Problem with the valve itself

Risk Factors

Factors that may increase your baby's risk of GERD include:

Symptoms

GER is very common in the first year of life. If GER symptoms worsen or don’t improve by 18 months, ask the doctor to re-evaluate your baby.

Symptoms may include:

Diagnosis

Your doctor will ask about your baby’s symptoms and medical history. A physical exam will be done. Your baby may need to see a pediatric gastroenterologist. This is a doctor who focuses on problems of the stomach and intestines.

Images may need to be taken of your baby's stomach and esophagus. This can be done with an upper GI series.

Your baby's bodily fluids and tissues may need to be tested. This can be done with an upper endoscopy with biopsy.

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 medicine—success or failure of medication may help your doctor understand the cause

Treatment

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

Lifestyle change can help improve symptoms. Your doctor may suggest these lifestyle changes:

In most cases, treatment starts with making lifestyle changes. Medication may be given if your baby's GERD doesn't improve. The medication can help to decrease acid in the stomach and help the area heal. Medication options may include:

  • Histamine-2 receptor drugs
  • Proton pump inhibitors

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

The cause of GERD is largely unknown. You can take steps to control it in your baby by:

  • Following lifestyle and dietary changes
  • Keeping your baby away from second-hand smoke
  • Keeping a diary of your baby's symptoms