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Gastroesophageal reflux disease in infants and children

Gastroesophageal reflux disease is present when the stomach contents come back up into the esophagus. This occurs in almost everyone from time to time. In adults it is often called "heartburn." Reflux is often the result of conditions that affect the lower esophageal sphincter (LES). The LES, a muscle located at the bottom of the esophagus, opens to let food in and closes to keep food in the stomach. When this muscle relaxes too often or for too long, acid refluxes back into the

esophagus, causing vomiting or heartburn. Everyone has gastroesophageal reflux from time to time. If you have ever burped and had an acid taste in your mouth, you have had reflux. The lower esophageal sphincter occasionally relaxes at inopportune times, and usually, all your child will experience is a bad taste in the mouth, or a mild, momentary feeling of heartburn.

Infants are more likely to have the lower esophageal sphincter (LES) relax when it should remain shut. As food or milk is digesting, the LES opens and allows the stomach contents to go back up the esophagus. Sometimes, the stomach contents go all the way up the esophagus and the infant or child vomits. Other times, the stomach contents only go part of the way up the esophagus, causing heartburn, breathing problems, or, possibly, no problems at all. Most babies spit up to some degree. It is probably due to immaturity of the lower esophageal sphincter (LES). Also, since young infants cannot sit up on their own, it may be easier for the stomach contents to reflux up into the esophagus. The problem usually goes away on its own when the baby is 12-18 months old.

As long as the baby is gaining weight and growing well, and has no other medical problems, there is no need to treat this condition. There are some conservative treatments (reflux precautions) that you can try if the vomiting is excessive. If the baby fails to gain weight appropriately, or if other medical conditions develop we will usually treat with medications and/or conservative treatment.

There are several theories about the cause of this condition. It may be that the lower esophageal sphincter is not functioning properly or the stomach empties too slowly. Children who complain of "heartburn" like symptoms, pain in the upper stomach area and the sensation of stomach contents coming up into the throat are often treated with medication and/or conservative measures. Some infants and children who have gastroesophageal reflux may not vomit, but may still have stomach contents move up the esophagus and spill over into the windpipe. This can cause asthma, pneumonia, and possibly even SIDS (sudden infant death syndrome). Infants and children with reflux who vomit frequently may not gain weight and grow normally. Inflammation (esophagitis) or ulcers (sores) can form in the esophagus due to contact with stomach acid. These can be painful and also may bleed, leading to anemia (too few red blood cells in the bloodstream). Esophageal narrowing (stricture) and Barrett's esophagus (abnormal cells in the esophageal lining) are long-term complications from inflammation.

Depending on the severity of the GER, medications may be tried. To reduce acid in the stomach, a medicine such as Zantac (ranitidine) may be used. To increase the strength of the LES and promote quick emptying of the stomach, another medicine such as cisapride may be used.

If drugs are not effective or the GER is severe, surgery may be needed. A fundoplication creates a valve mechanism by wrapping the upper part of the stomach (fundus) around the lower end of the esophagus. There are two types of fundoplication performed by our team. A Thal fundoplication is a partial wrap and a Nissen fundoplication is a total wrap. Your pediatric surgeon decides the type of fundoplication.

More information on gastroesophageal reflux disease (acid reflux, GERD)

What is gastroesophageal reflux disease (acid reflux)? - Gastroesophageal reflux disease (GERD) is a condition in which stomach contents, including acid, back up (reflux) into the esophagus, causing inflammation and damage to the esophagus.
What causes gastroesophageal reflux disease? - Gastroesophageal reflux disease is often the result of conditions that affect the lower esophageal sphincter (LES). Dietary and lifestyle choices may contribute to GERD.
What are the symptoms of gastroesophageal reflux disease? - Heartburn, also called acid indigestion, is the most common symptom of reflux. The most common symptoms in children are repeated vomiting, coughing, and other respiratory problems.
What're the complications of gastroesophageal reflux disease? - Chronic gastroesophageal reflux disease can lead to a number of serious problems, such as bleeding ulcers in the esophagus, and scarring leading to narrowing of the esophagus.
How is gastroesophageal reflux disease diagnosed? - Useful diagnosing methods include barium swallow X-rays, esophageal manometry, esophageal pH monitoring and EGD.
What're the treatments for gastroesophageal reflux disease? - Doctors recommend lifestyle and dietary changes for most people with GERD. Lifestyle modifications are a key component in the management of GERD and should be incorporated into all treatment stages.
What GERD medications treat gastroesophageal reflux disease? - Antacids remain the drugs of choice for quick relief of symptoms associated with GERD. H2-Receptor blockers are indicated for the prevention and relief of heartburn, acid indigestion and sour stomach.
What surgery treats gastroesophageal reflux disease? - Surgery is indicated for a small group of patients with GERD. The standard surgical treatment, sometimes preferred over longtime use of medication, is the Nissen fundoplication.
How to prevent gastroesophageal reflux disease with lifestyle? - A correct life style is effective to prevent the symptoms of GERD. Avoid foods that promote opening of the esophageal sphincter and increase acid reflux.
Gastroesophageal reflux disease in infants and children - Infants are more likely to have the lower esophageal sphincter (LES) relax when it should remain shut. Infants are easier for the stomach contents to reflux up into the esophagus.
What is hiatal hernia? - A hiatal hernia is named for the hiatus, an opening in the diaphragm between your chest and your stomach. There are two types of hiatal hernias. 
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