GERD stands for Gastroesophageal Reflux Disease. This occurs when you have a backflow of acid from your stomach enter the esophagus. This causes the “burn” from the term “heartburn,” and can damage the esophagus lining. Reflux is considered a disease when it is severe enough to impact a patient’s life and/or damage the esophagus. Additionally, it can cause asthma, sore throats, difficulty in swallowing, and can dissolve the enamel of the teeth. In the U.S. alone, approximately 7 million people suffer from GERD.
Symptoms of Gastroesophageal Reflux
Adults: Heartburn, regurgitation of gastric acid or sour contents into mouth, chest pain, difficult or painful swallowing, chest pain, frequent hiccups, asthma.
Babies: Frequent hiccups, crying, shows signs of hunger but only eats small amounts due to pain, screaming hungry but turning away from the breast, difficulty swallowing, frequent spit-ups, irritability, persistent crying, fussing after feedings, arching back, stiffening legs, asthma, hoarseness, stretching body, bad breath, poor weight gain, wheezing, coughing, moments with no breathing, hiccuping sounds as if the child is not breathing for a moment, diagnosis of colic, difficulty sleeping, diarrhea, choking.
Causes of Gastroesophageal Reflux
GERD is caused by reflux of the stomach acid into the esophagus. The sphincter (or “gate”) that keeps the lower end of the esophagus closed will relax, allowing acid to enter the esophagus.
Diagnosis of GERD
Upper GI: The child must drink a chalky substance called barium, which will display as white on an x-ray.
Video Floroscopic Swallow Study: This test is done to rule out or verify aspiration and/or swallow problems. It is similar to the upper GI, but is focused on the mouth and throat. A speech pathologist or occupational therapist may review the test and evaluate the swallow function. A variety of textures and liquid consistencies are given for a full evaluation.
Prolonged Intraesophageal pH Monitoring: This is a 24 hour pH probe and is the most sensitive test for reflux. A small plastic tube is passed through a nostril and into the esophagus. It is taped securely to the nose, and attached to a portable recording device. After a day of recording, the results are analyzed, so that associations can be made between the episodes of reflux and the symptoms.
Upper GI Endoscopy & Esophageal Biopsy: The child is sedated, and a flexible plastic tube with a tiny camera on the end is inserted through the mouth, down the throat, and into the esophagus and stomach. During this test, the esophageal and stomach walls are carefully inspected for signs of inflammation. Biopsies, which are pinhead-sized pieces of the surface tissue layer, are inspected under the microscope with immediate results for hiatal hernias, ulcers, and inflammation. Biopsy results may take several days, depending on the facility.
Treatment of Gastroesophageal Reflux
Treatment for reflux usually begins with an antacid. Avoid antacids that contain aluminum, choosing the form that contains magnesium instead. Prescriptions for reflux may include an H2RA drug, which decreases production of acid in the stomach. Prokinetic agents are used to speed stomach digestion and to tighten the “gate” from the stomach to the esophagus. Examples of these are Bethanechol and Metoclopramide.