GERD

Gastroesophageal reflux disease, or GERD is a condition that occurs when stomach contents, including stomach acid, flow back up into the esophagus (the tube that connects the mouth to the stomach). Overtime, this can cause troublesome symptoms and sometimes tissue damage within the lining of the esophagus. GERD is different than just experiencing reflux. 

Reflux itself refers to fluid or material moving up the esophagus. Reflux can happen occasionally in healthy people and generally does not cause problems.

This distinction is most important when comparing reflux in babies. Reflux in infants is incredibly common because their digestive system is still developing. It’s generally not a cause for concern and passes over time, rarely requiring treatment.

Symptoms and Presentation

Patients with GERD will typically report having chest pain. Healthcare providers often call this pain epigastric pain. They may also report “acid or metal” in their mouth after burps, or in the morning.  Pain is typically worse in the morning or after certain meals and can be made worse by eating certain foods (citrus, caffeine, spicy food).  Some patients may report general discomfort with eating, and some may report nausea.

Read personal stories from other patients with GERD

Risks and Causes

Some major risk factors of GERD include obesity and prior health issues like asthma and cystic fibrosis.  Many patients will have mild or intermittent (on and off) symptoms triggered by specific exposures, where some will have recurrent or chronic problems.   

Some infections can alter stomach acid production and movement leading to GERD symptoms.   Specific infections, like Helicobacter Pylori (H. pylori), are specifically capable of causing this issue, by colonizing the stomach and triggering an increase in acid production. Symptom causing versions of these bacteria are not as common in the United States or Europe, but highly common in the rest of the world.  Patients with GERD symptoms who are immigrants, first generation, frequent travelers, or live in communities with high rates of people who fit this description, should consider evaluation for H. Pylori (typically a stool test). 

While there are other rare conditions which can cause GERD and GERD Symptoms, management is often highly overlapping.

Treatment Approach

There are two approaches to managing GERD, first being identifying and avoiding triggers, and second being medications which reduce acid production, decreasing the amount of reflux and injury caused.  

Typically, pediatric GERD is of shorter duration, and requires less time to resolve, and less likely to progress to chronic needs.  One of the most common medications used are proton pump inhibitors (PPIs) (omeprazole, lansoprazole, etc). PPIs take a while to be fully effective but are the ideal choice for long term use.   It is recommended to use a PPI for 2 months and taper off.  Tapering off is needed because coming off it too quickly will make the stomach “rebound” and produce more acid. If symptoms persist or if symptoms do not improve, further evaluation may be needed, as other diseases can mimic GERD.   The majority of patients are able to successfully come off medication after 2-6 months of therapy

Another common medication used is H2 inhibitors (famotidine). H2 inhibitors work fast, but are not good for long term use, as your body gets used to them.  

In rare cases, a healthcare provider may suggest a surgical intervention called a Nissen Fundoplication, which mechanically limits reflux by tightening the lower esophageal sphincter (a ring of muscle keeping fluid from going upwards from the stomach).  These surgeries are highly effective, but typically reserved for severe/resistant cases, with the appropriate workup.

Adapted from IFFGD Publication: Gastroesophageal Reflux in Infants and Children by Carlo Di Lorenzo, MD, Mark S. Glassman, MD, and Paul E. Hyman, MD.