Division of Gastroenterology, Hepatology and Nutrition | When to Refer

Gastroesophageal reflux (GER) occurs when gastric acid flows upwards from the stomach into the esophagus. This reflux is a common occurrence—especially in young children—and often only leads to minor discomfort. However, frequent or intense GER can cause serious pain and have long-lasting consequences if not treated properly. These more prolonged and serious bouts of GER are known as gastroesophageal reflux disease (GERD).

What causes GERD?

GERD is usually triggered by a slight problem or irregularity with the lower esophageal sphincter (LES), the muscle that allows food to pass from the esophagus into the stomach and closes to keep food in the stomach.
Infants and young children are more likely to have a weaker, less developed LES, and thus are more prone to develop GERD.

Repeated exposure of the esophagus to stomach acid can lead to pain, ulcers and inflammation. In some cases, GERD can cause Barrett's esophagus, a pre-cancerous condition characterized by the presence of abnormal cells in the esophageal lining.

Diagnosing GERD in children

A child presenting the following symptoms may have GERD:

  • acid indigestion
  • a dry cough or asthma-like symptoms
  • trouble swallowing
  • fussiness or refusal to eat at mealtimes
  • frequent vomiting
  • nagging upper respiratory infection

GERD can often be diagnosed with a physical examination, but in some cases further testing such as an esophogastrodudenoscopy or impedance probe may be required. Other studies such as a chest x-ray or upper GI series are at times also useful to evaluate for other causes of GERD-like symptoms.

Management of pediatric GERD

The first step in GERD management is simple diet and/or lifestyle changes, such as eliminating certain foods from the child's diet or holding the infant in an upright position for 30 minutes after feeding. Should these prove ineffective, consider prescribing medication, such as an H2-blocker or proton-pump inhibitor. These medications decrease the amount of acid the stomach makes and are the most common used to treat GERD.

When to refer a child with GERD to a gastroenterology specialist

If a child's symptoms do not subside after two to three months of prescription treatment, or she requires a high dosage just to control symptoms, a referral to a gastroenterologist may be in order. In addition, an infant with GERD who refuses to eat, is vomiting frequently or experiencing any other symptoms leading to weight loss or failure to thrive should be referred to a specialist.

Once the child's symptoms have been controlled with appropriate medication and dosage, the gastroenterologist will be able to conduct additional testing to ensure the GERD symptoms are not indicative of chronic problems with similar presentations, such as food allergy, infection or inflammatory conditions.

Some patients with severe GERD may benefit from a surgical procedure called fundoplication, which reinforces the LES. However, most patients can be properly managed and followed with acid-controlling agents.