Gastroesophageal Reflux

Gastroesophageal reflux (GER) occurs when stomach contents reflux, or back up, into the esophagus during or after a meal.

The esophagus is the tube that connects the mouth to the stomach. A ring of muscle at the bottom of the esophagus opens and closes to allow food to enter the stomach. This ring of muscle 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.

GER often begins in infancy, but only a small number of infants continue to have GER as older children.

Almost all children and adults have a little bit of reflux, often without being aware of it. When refluxed material rapidly returns to the stomach, it does not harm the esophagus. However, in some children, the stomach contents remain in the esophagus and damage the esophageal lining. In other children, the stomach contents go up to the mouth and are swallowed again. 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. Other symptoms include:

Speak with your child’s health care provider if any of the following occur:

  • Increased amounts of vomiting or persistent projectile (forceful) vomiting
  • Vomiting fluid that is green or yellow or looks like coffee grounds or blood
  • Difficulty breathing after vomiting or spitting up
  • Pain related to eating
  • Food refusal that causes weight loss or poor weight gain
  • Difficult or painful swallowing

Treatment for reflux depends on the child’s symptoms and age. Medications include:

  • H2-blockers – help keep acid from backing up into the esophagus
  • Proton-pump inhibitors (PPIs) – block the production of stomach acid
  • Prokinetic agents – Make the LES close tighter so stomach acid cannot reflux into the esophagus

Besides using medication, you may be able to reduce symptoms other ways.

  • Have your child eat more frequent smaller meals.
  • Have your child avoid eating 2 to 3 hours before bed.
  • Raise the head of your child’s bed 6 to 8 inches by putting blocks of wood under the bedposts. Just using extra pillows will not help.
  • Have your child avoid carbonated drinks, chocolate, caffeine, and foods that are high in fat or contain a lot of acid (citrus fruits) or spices.

Surgery for GER in children is rare. However, surgery may be the best option for children who have severe symptoms that do not respond to medication.