Gastroesophageal Reflux in Children / Adolescents

What is Gastroesophageal Reflux?

Gastroesophageal reflux (GER) occurs when stomach contents reflux or go up into the esophagus (the tube that connects the mouth to the stomach), during or after a meal.

In some children, the stomach contents go up in the mouth and are swallowed again. Other symptoms include hoarseness, recurrent pneumonia, cough, wheezing and difficulty breathing or swallowing.

GER is very common in infancy, but only a small number of infants continue to have GER as older children. Evaluation by a physician is advised for anyone with persistent symptoms of GER.

There is a ring of muscle at the bottom of the esophagus that opens and closes, allowing food to enter the stomach. This ring is called the lower esophageal sphincter (LES). Reflux can occur when the LES opens, allowing stomach contents and acid to come back up into the esophagus. Almost all children and adults have a bit of reflux, without being aware of it.

When refluxed material rapidly returns to the stomach, it causes no damage to the esophagus. In some children, reflux occurs very frequently or does not clear from the esophagus, causing damage to the lining of the esophagus. When the refluxed material passes into the back of the mouth or enters the airways, the child may become hoarse, have a raspy voice or a chronic cough.

The doctor or nurse will talk with you about your child's symptoms, do a physical examination and may recommend tests to determine if reflux is the cause of symptoms. Often however, treatment is sometimes started without the need for any tests.

The Upper GI Series X-Ray

Barium (a chalky drink) is swallowed, and X-rays show the shape of the esophagus and stomach. This test can find a hiatal hernia, blockage and other problems that might mimic reflux.

Endoscopy

After the patient is given a sedative medication so he or she is asleep, a small flexible tube with a tiny camera is inserted through the mouth and down into the esophagus and stomach. The lining of the esophagus, stomach and small intestine can be examined, and biopsies (small pieces of the lining) can be painlessly obtained. The biopsies can later be examined with a microscope, looking for inflammation and other problems.

Esophageal pH Probe

A thin light wire with an acid sensor at its tip is inserted through the nose into the lower part of the esophagus. The probe then detects and records the amount of stomach acid coming back up into the esophagus when the child has symptoms such as crying, arching or coughing.

The treatment of reflux depends upon the child's symptoms and age. When a child or teenager is uncomfortable, or has difficulty sleeping, eating or growing, the doctor or nurse may first suggest a trial of medication. Medications used to treat reflux aim to decrease the amount of acid made in the stomach.

If the child continues to have symptoms despite the initial treatment, tests may be ordered to help find better treatments. It is rare for children to require surgery for GER.

Your child's doctor or nurse can discuss the treatment options with you and help your child feel well again.


Last Updated 10/2012