Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux (GER) occurs when gastric contents travel from the stomach into the esophagus. When this movement of fluid triggers symptoms that are bothersome, GER becomes gastroesophageal reflux disease (GERD).

If your baby is spitting up, they don’t necessarily need medication. In fact, they often outgrow this problem. What’s more, simple changes to the way you feed your baby could have a big effect on reflux. This animated video from Boston Children’s Hospital can provide answers for dealing with infant reflux.

The most common reason that gastric contents enter the esophagus in infants and children is because the lower esophageal sphincter (LES) relaxes, letting gastric fluid escape into the esophagus. This relaxation is normal, but can happen more frequently in some children. The diaphragm and stomach are also important in supporting the LES, so when one or both aren’t working properly, reflux may worsen. Finally, if your child’s esophagus doesn’t move normally, any reflux that enters the esophagus isn’t cleared well, putting children at risk for symptoms and esophageal damage.

Because GERD often gets blamed for a variety of symptoms, it’s important to see a clinician who is not only able to help to make an accurate diagnosis of GERD but who also considers other possible diagnoses to avoid unnecessary treatment.

The symptoms of GER and GERD can vary from “spitting up” to severe difficulties with vomiting, esophageal inflammation, pain, and lung problems.

Each child may experience GERD differently. Common symptoms include:

• Heartburn
• Chest pain
• Bringing food up into the mouth
• Bad breath
• Stomachache or pain during or after eating
• Fussiness around mealtimes
• Hiccups
• Gagging or choking
• Frequent cough, coughing fits at night, or both
• Wheezing
• Vomiting
• Inability to gain weight
• Gastrointestinal bleeding

Spitting up is a normal occurrence for young infants. As long as your child is growing well and not developing other problems, such as breathing difficulties, the condition needs no treatment and will typically resolve on its own with time.

However, GERD may merit treatment when your child has:

• Frequent vomiting that results in poor weight gain and growth
• Pain that interferes with daily functioning
• Complications of reflux such as inflammation (esophagitis), ulcers (sores) that form in the esophagus, or respiratory problems that result in hospitalization

In order to properly diagnose your child’s condition, your doctor may recommend one or more of the following procedures:

• High-resolution esophageal manometry: A thin tube is inserted through the nose or mouth into the esophagus to measure the pressure within the esophagus and the lower esophageal sphincter.
• Endoscopy: This procedure involves the use of a thin and lighted tube placed through the nose or mouth into the esophagus to "see" inside the esophagus.
• pH impedance testing: An impedance study (with pH monitoring) evaluates acid and non-gastroesophageal reflux to determine if contents from the stomach are leaking into the esophagus (food tube) and are associated with symptoms.
• BRAVO® placement: During this test, we attach a wireless capsule to the esophagus to record what the acid does inside the body.
• Upper GI (gastrointestinal) endoscopy: In this test, a flexible tube is placed from the mouth into the stomach. This allows visualization and sampling (biopsies) of the different organs to see if there is underlying inflammation or a reason for the GERD symptoms.
• Upper GI series: This test examines the organs of the upper part of the digestive system using barium, a radio-opaque liquid that coats the inside of organs so that they will show up on an X-ray.
• Gastric emptying studies: These tests determine whether or not the stomach contents empty into the small intestine properly. Delayed gastric emptying can contribute to GERD, allowing stomach contents to back up into the esophagus.

GERD treatment varies with age. The first step in treating normal reflux in infants is to look for solutions that do not require the use of medication. Your gastroenterology specialist may recommend trying different ways of positioning and feeding your infant.

Many babies with GER will outgrow it by the time they are about one year old, as the lower esophageal sphincter becomes stronger. For others, medications that take away the stomach acid, or make the stomach empty faster, can minimize reflux, vomiting and heartburn. Lifestyle and dietary changes may also help.

For more severe cases of intractable GERD, we provide advanced therapies not routinely available. We may recommend surgery to reinforce the lower esophageal sphincter and mechanically discourage reflux.

For patients with GERD that have undergone surgery and continue to have problems, we offer a series of specialized treatments that include medications to relax the stomach, such as injections of Botox or medications to improve gastric emptying and help reduce pain.