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.
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:
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:
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:
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:
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:
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.
GI Kids—North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition
National Institute of Diabetes and Digestive and Kidney Diseases
Canadian Digestive Health Foundation
About Kids Health—The Hospital for Sick Children
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 10, 2016.
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 July 28, 2015. Accessed September 28, 2016.
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 2016 by Kari 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.