Gastroesophageal reflux (GER) is a back up of acid or food from the stomach to the esophagus. The esophagus is the tube that connects the mouth and stomach. GER is common in babies. It causes them to spit up. Most babies outgrow GER within 12 months.
After 18-24 months, esophageal injury and additional symptoms may point to gastroesophageal reflux disease (GERD). GERD is the regular flow of acid to the esophagus. GERD requires treatment to avoid complications.
Gastroesophageal Reflux Disease
Food and acid back up into the esophagus from the stomach.
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The lower esophageal sphincter (LES) is a muscular ring between the esophagus and the stomach. It relaxes to let food pass into the stomach, then closes shut to prevent it from backing up. With GERD, the ring doesn't close as tightly as it normally should. This causes acid reflux, a burning sensation that can be felt below the breastbone.
The following factors contribute to GERD:
- Increased relaxation of the LES
- Problems with LES muscle tone
- Problems with the nerves that control the LES
- Delayed emptying of the stomach
- Genetics and family history
Factors that may increase your baby's chance of GERD include:
GER is very common in the first year of life. If GER symptoms worsen or don’t improve by 18 months, ask the doctor to re-evaluate your baby.
Symptoms may include:
- Spitting up or vomiting
- Not growing or gaining weight
- Refusal to feed or difficulty feeding
- Irritability or fussiness during or after feeding
- Arching of back or other movements during or after feeding
- Regurgitation or bloody vomit
- Breathing problems, including during sleep
- Difficulty swallowing
- Cough or wheezing
- Disturbed sleep
- Excessive crying
You will be asked about your baby’s symptoms and medical history. A physical exam will be done. Your baby may need to see a pediatric gastroenterologist. This is a doctor who focuses on problems of the stomach and intestines.
Images may need to be taken of your stomach and esophagus. They may be done with a biopsy. Images can be done with:
Other tests may include:
- 24-hour pH monitoring—a probe is placed in the esophagus to keep track of the acid in the lower esophagus
- Short trial of medications—success or failure of medication may help your doctor understand the cause
Talk with the doctor about the best treatment plan for your baby. Treatment options include the following:
Lifestyle changes can help improve symptoms.
Your baby's doctor may suggest these lifestyle changes:
- Try a hypoallergenic formula for 1-2 weeks. This formula has removed items linked with common allergic reactions.
- Provide small, frequent feedings.
- Thicken your baby’s formula or milk. Use rice, cereal or another thickening agent.
- Use a different pre-thickened formula.
- Burp your baby more often. For example, burp your baby every 1-2 hours after being fed.
- Make sure your baby is in an upright position during feeding. Keep your baby upright for 30 minutes after being fed.
- Keep a diary of your baby's symptoms.
Ask your doctor about sleeping positions. These positions depend on your baby's age. Young babies should always be placed on their back because of the risk of
sudden infant death syndrome.
- Keep your baby away from secondhand smoke.
In most cases, treatment starts with making lifestyle changes. Medication may be given if your baby's GERD does not improve. The medication can help to decrease acid in the stomach and help the esophagus heal. Medication options may include:
- H-2 blockers
- Proton pump inhibitors
Surgery or endoscopy may be recommended with
more severe cases.
The most common surgery is called
fundoplication. During this procedure, a part of the stomach will be wrapped around the stomach valve. This makes the valve stronger. It should prevent stomach acid from backing up into the esophagus. This surgery is often done through small incisions in the skin.
There are no current guidelines to prevent GERD.
GI Kids—North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition
Gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) in infants. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at:
http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/ger-and-gerd-in-infants/Pages/facts.aspx. Accessed March 19, 2018.
Gastroesophageal reflux disease in infants. EBSCO DynaMed Plus website. Available at:
http://www.dynamed.com/topics/dmp~AN~T116575/Gastroesophageal-reflux-disease-GERD-in-infants. Updated April 21, 2016. Accessed March 19, 2018.
1/6/2009 DynaMed Plus Systematic Literature Surveillance
http://www.dynamed.com/topics/dmp~AN~T116575/Gastroesophageal-reflux-disease-GERD-in-infants: Orenstein SR, McGowan JD. Efficacy of conservative therapy as taught in the primary care setting for symptoms suggesting infant gastroesophageal reflux. J Pediatr. 2008;152(3):310-314.
1/20/2015 DynaMed Plus Systematic Literature Surveillance
http://www.dynamed.com/topics/dmp~AN~T116575/Gastroesophageal-reflux-disease-GERD-in-infants: National Institute for Health and Care Excellence. Gastro-oesophageal reflux disease: Recognition, diagnosis and management in children and young people. January 2015. Available at: https://www.nice.org.uk/guidance/ng1. Accessed March 10, 2016.
Last reviewed March 2018 by
EBSCO Medical Review BoardKari Kassir, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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