What Is Gastroesophageal Reflux (GER)?
Gastroesophageal reflux (GER), also called acid reflux, is a common problem that causes heartburn. Many people have heartburn (or acid indigestion) regularly and it's not usually a cause for concern. This uncomfortable, burning pain in the lower chest area happens to many adults after eating a big meal or spicy foods.
But with GER, reflux happens after nearly every meal and causes noticeable discomfort. After eating, people with GER feel a burning sensation in the chest, neck, and throat.
GER isn't just a problem for adults. Kids, teens and even babies can have gastroesophageal (gas-tro-ih-sah-fuh-JEE-ul) reflux too. In infants, it can cause vomiting and fussiness after feeding. Most kids outgrow GER over time, but some will need medical treatment.
What Is Gastroesophageal Reflux Disease (GERD)?
Gastroesophageal reflux disease (GERD) is when someone has acid reflux more than twice a week. GERD can cause problems like poor growth, vomiting, or damage to the esophagus. It's a more serious condition than GER. Doctors usually treat it with medicine.
What Are the Signs & Symptoms of GER?
Heartburn is the most common symptom of GER. It can last up to 2 hours and tends to be worse after meals.
Babies and young children with GER might not gain weight as expected. They also can have these problems while they eat and after:
- spitting up or vomiting often, especially after meals
- choking or wheezing (if the contents of the reflux get into the windpipe and lungs)
- wet burps or wet hiccups
- spitting up that continues after a child's first birthday (when it stops for most babies)
- being fussy or crying a lot after eating
- refusing to eat or eating only small amounts
These symptoms may get worse if a baby lies down or is placed in a car seat after a meal.
What Happens in GER?
The burping, heartburn, and spitting up in GER happen when acidic stomach contents move backward into the esophagus. The esophagus is a tube that carries food and liquids from the mouth to the stomach. It is separated from the stomach by a small muscle (the esophageal sphincter). This muscle opens and lets food and liquid enter the stomach and closes to prevent the food and liquid from leaking back into the esophagus.
GER happens when the muscle relaxes at the wrong time or doesn't close as it should.
In babies with GER, breast milk or formula regularly goes back up (refluxes) into the esophagus, and sometimes out of the mouth. Sometimes babies forcefully spit up or have "wet burps." Most babies outgrow GER between the time they are 1 or 2 years old.
But in some cases, GER symptoms last. Kids with developmental or neurological conditions, such as cerebral palsy, are more at risk for GER. Their symptoms can last longer and be more severe.
What Problems Can Happen?
Some children develop problems from GER. The constant reflux of stomach acid can lead to:
- breathing problems (if the stomach contents enter the trachea, lungs, or nose)
- redness and irritation in the esophagus, a condition called esophagitis
- bleeding in the esophagus
- scar tissue in the esophagus, which can make it hard to swallow
These problems can make eating painful, so GER can interfere with proper nutrition. If your child isn't gaining weight as expected or is losing weight, be sure to tell your doctor.
How Is GER Diagnosed?
In older kids, doctors usually diagnose reflux by doing an exam and asking about the symptoms. Try to keep track of the foods that seem to bring on symptoms in your child. This can help the doctor find out what's causing the problem.
In younger children and babies, doctors might run these tests to diagnose GER or rule out other problems:
- Barium swallow. This special X-ray can show liquid going up into the esophagus, any irritation in the esophagus, and problems in the upper digestive tract. For the test, your child will swallow a small amount of a chalky liquid (barium). This lets doctors see the swallowing process.
- 24-hour impedance-probe study. This is the most accurate way to detect reflux and how often it happens. A thin, flexible tube goes through the nose into the esophagus. The tip rests above the esophageal sphincter to watch the acid levels in the esophagus and find any reflux.
- Milk scans. This series of X-ray scans tracks a special liquid as a child swallows it. The scans can show whether the stomach is slow to empty liquids and whether the refluxed liquid is being inhaled into the lungs.
- Upper endoscopy. In this test, doctors directly look at the esophagus, stomach, and part of the small intestines using a tiny fiber-optic camera. They also might do a biopsy (take a small sample) of the lining of the esophagus to rule out other problems and see if GER is causing other problems.
How Is GER Treated?
Treatment for GER depends on the problems it causes and how severe they are.
In babies, doctors sometimes suggest thickening the formula or breast milk with up to 1 tablespoon of oat cereal to reduce reflux. Making sure the baby is seated or held upright during feedings also can help.
Older kids often get relief by avoiding foods and drinks that seem to trigger GER symptoms. Often, these include:
- citrus fruits
- food and drinks with caffeine
- fatty and fried foods
- garlic and onions
- spicy foods
- tomato-based foods and sauces
For reflux that happens at night, it can help to raise the head of a child's bed 6 to 8 inches. Doctors also may have advice about things can add to GER symptoms, such as obesity, some kinds medicines, and in teens, smoking and alcohol use.
If symptoms continue, the doctor may also prescribe medicine, such as:
- H2 blockers, to help block the production of stomach acid
- proton pump inhibitors, so the stomach makes less acid
- prokinetics, which help the lower esophageal sphincter muscle work better and the stomach empty faster
Rarely, medical treatment doesn't help and a child can't grow well or has other problems. Then doctors might recommend a procedure called fundoplication. In this surgery, doctors create a valve at the top of the stomach by wrapping a part of the stomach around the esophagus.
When Should I Call the Doctor?
If your child has GER symptoms, talk with your doctor. With proper diagnosis and treatment, kids can get relief and avoid longer-term health problems.