Children's Hospital Colorado

Gastroesophageal Reflux and Heartburn

What is gastroesophageal reflux (GERD)?

Gastroesophageal reflux (GERD) refers to episodes when the stomach contents come up into the throat or mouth. In babies, it typically comes out of the mouth, which we call "spitting up." Older children and teenagers can experience heartburn, sore throats and trouble swallowing.

What causes reflux?

Reflux occurs throughout the day in most people, especially after meals, and is related to relaxation of the muscle at the top of the stomach.

Who gets reflux?

Reflux is a normal occurrence in people of all ages and races.

What are the signs and symptoms of gastroesophageal reflux?

Reflux is a normal process that occurs when the muscle at the top of the stomach relaxes and allows the contents of the stomach to pass back up into the esophagus. It most often occurs after meals and most of the time there are no symptoms or complaints associated with the episodes. Children can have symptoms associated with reflux when they have many reflux episodes or the esophagus becomes irritated by the acid reflux.

Some of the complaints children with reflux have are heartburn, upper abdominal abdomen, chest pain, pain with swallowing, food becoming stuck in the throat, regurgitation, spitting up and vomiting. Reflux can cause sore throat and hoarseness. It may also cause sinusitis, ear infections and chronic cough.

Reflux can cause scarring of the esophagus, called a stricture, however this usually occurs only after years of chronic reflux or when a child has had previous surgery on the esophagus. Stricture causes difficulty with swallowing solids in particular.

What tests are used to diagnose gastroesophageal reflux?

Most of the time no tests are required to determine if a child has reflux. If they have common symptoms, a discussion of medical history and physical exam are enough to make the diagnosis. Often a doctor will recommend medications which decrease acid in the stomach to see if the child improves.

If a child has persistent vomiting or weight loss, a set of X-rays called an "upper GI series" are taken. During this test, the child drinks barium, a liquid that can be seen on an X-ray to evaluate the anatomy of the GI tract. This helps doctors rule out an anatomical problem as the source of reflux.

A test called a pH probe and impedance studies are done to determine how much reflux a child has by measuring the amount of stomach acid in the esophagus, to see if other complaints are caused by reflux and sometimes to determine if treatment is working.

Endoscopy is performed to determine if there is inflammation of the esophagus or stomach and to determine if there is an underlying cause of the reflux. During an endoscopy, a tiny camera is passed through a child's digestive system and down into the stomach to look at the inside of these organs. Usually, endoscopy is performed under anesthesia.

Esophageal and gastric motility testing can be done to determine if muscular contractions are moving food through the GI tract appropriately.

How do doctors at Children's Hospital Colorado make a diagnosis?

The doctors at Children's Colorado Digestive Health Institute look at a child's growth and development, take a thorough history and perform a physical examination. That is often enough to diagnose reflux. If further testing is required, our doctors are able to perform and evaluate any of the above testing as needed.

How is gastroesophageal reflux treated?

The most important and initial treatment of reflux include lifestyle changes and reflux precautions. In babies, formula can be thickened to decrease the amount of spitting up, however this does not change the actual number of reflux episodes. Positioning a baby with his or her head slightly elevated can be useful.

Older children are instructed to avoid caffeine, chocolate, greasy food and tomato sauce, and they should avoid eating or drinking in the two hours before bedtime. The head of their bed can also be elevated.

Medications which either neutralize the stomach acid or decrease the production of stomach acid can be used to allow healing of inflammation caused by reflux. There are three types of medications, antacids that neutralize stomach acid, H2 blockers like Zantac, which decrease acid production and Proton Pump Inhibitors (PPIs) like Prilosec, which are the most potent inhibitors of acid production.

In a few children, reflux can be so severe or have such severe complications that surgery is required to tighten the muscle at the top of the stomach to control the reflux. This is done by a pediatric surgeon and can be done laparoscopically, a surgical technique that makes a few very small incisions instead of one large one which makes healing much faster.

Why choose Children's Colorado for your child's gastroesophageal reflux?

The doctors at the Digestive Health Institute are experts at diagnosing and treating reflux and its complications. All tests possibly needed in the evaluation are available at Children's Colorado. The Aerodigestive Clinic is a multispecialty clinic which includes gastrointestinal, ear, nose and throat, and pulmonary doctors who work together to evaluate children in who reflux may be a significant issue in their medical problems.

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