Heartburn Causes, Symptoms, and Diagnosis
If you have never been diagnosed with asthma, seek treatment first with your internist or family physician. Your internist or family physician may refer you to an asthma specialist or a physician who treats gastrointestinal disorders, depending on the nature of your symptoms. Eat smaller meals. Less food in your stomach may minimize the possibility of reflux. Try eating five to six “mini-meals” spaced throughout the day and early evening, instead of three larger meals.
In most infants the junction between the esophagus and stomach is “closed,” opening only to allow passage of formula or breast milk into the stomach or to allow the escape of swallowed air via burping. Gastroesophogeal reflux (GER) is the upward flow of stomach contents from the stomach into the esophagus (“swallowing tube”). While not required by its definition, these contents may continue from the esophagus into the pharynx (throat) and may be expelled from the mouth, and in infants, through the nostrils.
If your child has reflux more than twice a week for a few weeks, it could be GERD. Children and adults who do not improve with medical treatment may require surgical intervention. Surgical treatment includes “fundoplication,” a procedure that tightens the lower esophageal muscle gateway (lower esophageal sphincter, or LES).
Over the years, laparoscopic antireflux procedures (first reported in children in 1993) have replaced the open approach to become the primary surgical approach for the treatment of GERD [11, 21]. Caring for a baby or child with chronic acid reflux or gastroesophageal reflux disease (GERD) can be challenging. GERD causes food and stomach acid to reflux or flow up into the esophagus – the muscular tube that connects the mouth and stomach – after your child eats. Understandably, babies and children with GERD can become fussy and irritable. They may not sleep well and may also be reluctant to eat.
Always remember to check with your infant’s doctor before elevating the head of the crib if he or she has been diagnosed with gastroesophageal reflux. This is for safety reasons and to reduce the risk for SIDS and other sleep-related infant deaths. Ask your child’s doctor to profile any of the medications he or she is taking–some may irritate the lining of the stomach or esophagus.
It is also recommended to keep a record of the time, type, and amount of food eaten. The pH readings are evaluated and compared with the patient’s activity for that time period to help determine possible GERD triggers. Infants and children with GERD who vomit frequently may not gain weight and grow normally.
The options for treating gastro-oesophageal reflux disease are improving all the time, with new medicines and surgical options being discovered alongside a better understanding of why a child develops gastro-oesophageal reflux disease. Stomach acid may also change the cells of the lining of your esophagus. This change, called Barrett’s esophagus, increases the likelihood of certain cancers of the esophagus.
In GERD patients, the lower esophageal sphincter – the ring of muscle that closes off the stomach from the esophagus – does not work properly. This allows digestive acid to enter the esophagus and can cause damage over time. Heartburn is the most common symptom of GERD, but other symptoms may include coughing, wheezing, chest pain, hoarseness, difficulty swallowing and frequent throat clearing and regurgitation.
Gastroesophageal reflux disease (GERD) can be thought of as chronic symptoms of heartburn. The term refers to the frequent backing up (reflux) of stomach contents (food, acid) into the esophagus — the tube that connects the throat to the stomach.
Symptoms of GER
Uncomplicated postoperative care for fundoplications include early advancement of diet to liquids then pureed and outpatient documentation of resolution of symptoms. Complications of surgery include both short term (intraoperative, postop dysphagia, and hyperflatulence) and long term (failed fundoplication). The learning curve for antireflux surgery is approximated to be between 20 and 50 cases but continues to extend as the surgeon is referred more complicated cases. In the case of failed fundoplication, a “redo” procedure is safe and appropriate in the hands of an experienced surgeon. The clinical symptoms of reflux that lead to GERD may vary according to the age of the child.
Symptoms abate without treatment in 60% of infants by age 6 months, when these infants begin to assume an upright position and eat solid foods. Resolution of symptoms occurs in approximately 90% of infants by age 8-10 months. Approximately 85% of infants vomit during the first week of life, and 60-70% manifest clinical gastroesophageal reflux at age 3-4 months. Gastroesophageal reflux is most commonly seen in infancy, with a peak at age 1-4 months.
There are variations in how much of the esophagus is covered by the stomach and whether the stomach wraps around the front or the back. This procedure can be done laparoscopically (with several small incisions) or through a traditional larger incision. Outcomes are similar for both procedures. Depending on the child’s specific needs, a feeding tube may be placed in the stomach at the same surgery.