Gastroesophageal reflux (GER) is a condition when stomach contents reflux or go up into the esophagus. The esophagus is the tube that connects the mouth to the stomach. With GER, reflux can happen during or after a meal.

In some children, stomach contents go up into the mouth and are swallowed again. Gastroesophageal reflux (GER) occurs when reflux of stomach contents causes complications or symptoms. Complications include weight loss / inadequate weight gain, irritability, feeding refusal, hoarse voices, repeat pneumonias, cough, wheezing, and difficulty breathing or swallowing.

Incidence of Gastroesophageal Reflux

GER is common in infancy. Only a small number of infants continue to have GER as they get older. Evaluation by a doctor is advised for anyone with continued symptoms of GER.

Causes of Gastroesophageal Reflux

There is a ring of muscle at the bottom of the esophagus that opens and closes. This allows food to enter the stomach. This ring is called the lower esophageal sphincter (LES). Reflux happens when the LES opens. At this time, some stomach contents and acid come back up into the esophagus. Almost all children and adults have some reflux, without being aware of it.

When refluxed material rapidly returns to the stomach, it causes no damage to the esophagus. In some children, reflux occurs often or does not clear. This can cause damage to the lining of the esophagus. When the refluxed material goes into the back of the mouth or the airways, the child may become hoarse, have a raspy voice or a chronic cough.

Diagnosis of Gastroesophageal Reflux

The doctor or nurse will talk with you about your child's symptoms, do a physical exam and may recommend tests to see if reflux is the cause of symptoms. Treatment is sometimes started without the need for any tests.

The Upper GI Series X-Ray

Barium (a chalky drink) is swallowed, and X-rays show the shape of the esophagus and stomach. This test can find a hiatal hernia, blockage and other problems that might look like reflux.

Endoscopy 

After the patient is given a medication so they are asleep, a small flexible tube with a tiny camera is put in the mouth and down into the esophagus and stomach. The lining of the esophagus, stomach and small intestine can be seen. Biopsies (small pieces of the lining) can be taken. The biopsies can be looked at with a microscope to check for inflammation and other problems.

Esophageal pH Probe

A thin light wire with an acid sensor at its tip is put through the nose into the lower part of the esophagus. The probe detects and records the amount of stomach acid coming back up into the esophagus when the child has symptoms such as crying, arching or coughing.

Treatment of Gastroesophageal Reflux

The treatment of reflux depends upon the child's symptoms and age. When a child or teenager is uncomfortable, has difficulty sleeping, eating, or growing, the doctor or nurse may suggest a trial of medication. Medications used to treat reflux aim to decrease the amount of acid made in the stomach.

If the child continues to have symptoms despite the initial treatment, your doctor or nurse may order one of the tests described above to help find better treatments. It is rare for children to need surgery for GER.

Your child's doctor or nurse can discuss the treatment options with you and help your child feel well again.