However, it can be seen in children of all ages, even healthy teenagers. Two major areas of controversy surround the relationship between gastroesophageal reflux and both apnea and otolaryngologic disease. Early studies appeared to demonstrate a link between gastroesophageal reflux and obstructive apnea (including an association with apparent life-threatening events [ALTEs]); however, recent investigations now suggest only a weak relationship between these disorders. For many years, gastroesophageal reflux during infancy and childhood was thought to be a consequence of absent or diminished LES tone. However, studies have shown that baseline LES pressures are normal in pediatric patients, even in preterm infants.
How are heartburn and reflux diagnosed/evaluated?
Caregivers record the occurrence of symptoms (manually or by using an event marker on the probe); the symptoms are then correlated with reflux events detected by the probe. A pH probe can also assess the effectiveness of acid-suppression therapy. An impedance probe has the ability to detect nonacid reflux as well as acid reflux. Infants who have symptoms consistent with GERD and no severe complications may be given a therapeutic trial of medical therapy for GERD; improvement or elimination of symptoms suggests GERD is the diagnosis and that other testing is unnecessary.
Nonetheless, anti-GERD procedures have many complications and high failure rates. The true benefit of surgery for patients who have failed medicine therapy is controversial. As with medications, current surgical procedures cannot cure GERD. About 15 to 66% of people still require anti-GERD medications after surgery.
Upper GI series or barium swallow. This test looks at the organs of the top part of your childâ€™s digestive system. It checks the food pipe (esophagus), the stomach, and the first part of the small intestine (duodenum). Your child will swallow a metallic fluid called barium.
You may feel like you have food stuck in your throat or like you are choking or your throat is tight. GERD can also cause a dry cough and bad breath.
- Specific symptoms may include a feeling of fullness (particularly early in the meal), bloating, and nausea.
- The LES is a valve-like muscle (like a thick rubber band) that forms a barrier between your esophagus and your stomach.
- Progressively worsening projectile vomiting in the first months of life is concerning for pyloric stenosis and requires immediate imaging and surgical referral.
- Your doctor is the best source of information on how to use medications for GERD.
- Heartburn that occurs more than twice a week may be considered GERD, and it can eventually lead to more serious health problems.
Youâ€™re at greater risk for developing GERD if you smoke, are obese, or are pregnant. These conditions weaken or relax the lower esophageal sphincter, a group of muscles at the end of the esophagus. When the lower esophageal sphincter is weakened, it allows the contents of the stomach to come up into the esophagus. PPI medications are available over the counter, though you should see a doctor if you have any symptoms that arenâ€™t going away.
In these cases, especially when associated with food impaction, eosinophilic esophagitis must be ruled out prior to attempting any mechanical dilatation of the narrowed esophageal region. In refractory cases of gastroesophageal reflux or when complications related to reflux disease are identified (eg, stricture, aspiration, airway disease, Barrett esophagus), surgical treatment (fundoplication) is typically necessary. The prognosis with surgery is considered excellent.
Surgical Treatments for GERD
The surgical morbidity and mortality is higher in patients who have complex medical problems in addition to gastroesophageal reflux. Indeed, most cases of gastroesophageal reflux in infants and very young children are benign, and 80% resolve by age 18 months (55% resolve by age 10 mo), although some patients require a â€œstep-upâ€ to acid-reducing medications. Symptoms that persist after age 18 months suggest a higher likelihood of chronic gastroesophageal reflux; in such cases, the long-term risks of the condition are increased. Surgical intervention such as gastrostomy or fundoplication (see the image below) is required in only a very small minority of patients with gastroesophageal reflux (eg, when rigorous medical step-up therapy has failed or when the complications of gastroesophageal reflux pose a short- or long-term survival risk).
There may be other factors causing them, and a doctor will be able to suggest the best treatment options for you. The 24-hour pH probe, which monitors esophageal pH, is also an effective test for people with chronic cough. Another test, known as MII-pH, can detect nonacid reflux as well. The barium swallow, once the most common test for GERD, is no longer recommended. GERD can be difficult to diagnose in people who have a chronic cough but no heartburn symptoms.
Infants with GERD require treatment, typically beginning with conservative measures. Other causes include food allergies, most commonly milk allergy. A less common cause is gastroparesis (delayed emptying of the stomach), in which food remains in the stomach for a longer period of time, maintaining a high gastric pressure that predisposes to reflux. Infrequently, an infant can have recurrent emesis that mimics GERD because of a metabolic disease (eg, urea cycle defects, galactosemia, hereditary fructose intolerance) or an anatomic abnormality (such as pyloric stenosis or malrotation).
Research on this question is still ongoing. Some experts are concerned that the use of acid-blocking drugs in people with peptic ulcers may mask ulcer symptoms and increase the risk for serious complications. Over-the-counter antacids and H2 blockers.