Gastroesophageal Reflux Disease (GERD)

Gastroesophageal Reflux Disease

1. What causes gastroesophageal reflux disease (GERD)?

Gastroesophageal reflux (GER) happens when the stomach contents flow back into the esophagus (the tube that connects the mouth to the stomach) which can happen with or without vomiting. GER is a normal process which can happen several times a day in healthy infants and children. However, when GER happens too often it can hurt or irritate your esophagus.  This is when it becomes gastroesophageal reflux disease or GERD.

2. What are the symptoms of GERD?

• Difficult or painful swallowing
• Frequent complaints of abdominal pain (tummy ache)
• Frequent regurgitation (stomach contents go into the mouth then are swallowed again)
• Weight loss or poor weight gain
• Coughing
• Wheezing
• Recurrent pneumonia

3. What causes GERD?

Gastroesophageal reflux happens when the sphincter muscle at the bottom of the esophagus relaxes at the wrong time and results in stomach contents backing up into the esophagus. When this happens frequently it can lead to gastroesophageal reflux disease (GERD). Children with conditions such as obesity, asthma, diabetes and prematurity have an increased risk of GERD.

4. How is GERD diagnosed?

Your doctor will physically examine your child and ask about any symptoms they may be having. If GERD is suspected, your doctor may want to do further testing to make sure there are no problems with your child’s esophagus, stomach and small intestine.

Testing includes

• Barium X-ray (Upper GI series) – barium is swallowed during an x-ray and the x-ray shows the shape of the esophagus and stomach
• Endoscopy – allows the doctor to examine the lining of the esophagus and stomach and the first part of the small intestine. Biopsies are taken which will show if there is any inflammation or other problems
• Esophageal PH probe – identifies if there is any stomach acids in the esophagus. If stomach acid in the esophagus has been detected the probe will be able to tell how much.

5. What is the current treatment for GERD?

Gastroesophageal reflux disease is treated by a combination of the following:

1. Lifestyle changes

• For older children only (not infants or younger children) lateral left sided or prone sleeping position is recommended
• Raise the head of the bed
• Avoid chocolate, peppermint, fried fatty foods due to the fact that it lowers you LES valve pressure
• Avoid spicy and acid containing foods that may irritate the esophagus lining
• Eat small frequent meals rather than large meals
• Try to not eat or drink 3 – 4 hours prior to going to bed

2. Medications

• H -2 Receptor blockers – are medications used to reduce acid production. They are have a rapid onset of action and are useful for on demand treatment

Examples include cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid)   and ranitidine (Zantac)

• Proton pump inhibitors (PPI) – block the acid production and give the damaged esophageal tissue time to heal. Therefore they are the most effective drug to control GERD symptoms. Examples include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), rabeprazole (Aciphex) and dexlansoprazole (Dexilant).

Links:

GERD FAQ
Cartoongi – GERD Video
http://www.gikids.org/content/8/en/reflux-gerd
http://cdhf.ca/bank/document_en/12understanding-gerd-.pdf#zoom=100

REMINDER: This informati
on is intended to provide general information and should not be used to base a diagnosis or treatment. Please consult the doctors about your specific condition and the approach for treatment.