Gastroesophageal reflux disease, or GERD, results when acid flows back from the stomach into the esophagus. When a person eats, food goes from the mouth to the stomach through the esophagus. At the end of the esophagus there is a muscle, called the lower esophageal sphincter, which prevents stomach contents from flowing back out. Reflux occurs when the lower esophageal sphincter fails to close completely.
Features
Children with GERD differ from adults in that they do not report the typical heartburn or chest pain associated with GERD. According to the National Digestive Diseases Information Clearinghouse, throat pain or laryngitis is a common complaint of children with reflux. This results from irritation of the stomach acid to the back of the throat. Other symptoms of GERD in children include repeated vomiting, coughing and other respiratory problems, such as wheezing.
According to the University of Maryland Medical Center, symptoms in the throat include hoarseness and the sensation of having something stuck in the back of the throat. Children may have trouble swallowing food, either as a result of a spasm of the esophagus due to the reflux, or because chronic reflux can result in a stricture, or a narrowing of the esophagus.
Considerations
There are several factors that can weaken the lower esophageal sphincter and cause GERD. In children, drinking caffeine-containing products and eating fatty and fried foods can predispose them to reflux. Acidic foods, such as citrus fruits and pizza, can also trigger reflux symptoms. Children with reflux benefit from lifestyle changes, such as avoiding foods that provoke the throat pain and the other symptoms. Another change is to eat small, frequent meals instead of big meals.
Treatment
Over-the-counter medicines can help to control reflux symptoms, but in children it is important not to use products that contain aspirin, as this can increase the risk of Reye's syndrome, a condition that affects the liver and the brain. Prescription strength medicines include H2 blockers, which decrease acid production, and proton pump inhibitors, which are more effective than H2 blockers in reducing acid production and also help heal the esophagus.
Warning
If reflux symptoms persist despite medical treatment, the child may need further evaluation with a barium swallow, a radiologic study that checks for anatomical problems that may be causing reflux, or an endoscopy, during which a tube is inserted in the mouth of the anesthetized child to visualize the esophagus and the stomach
Surgery
Occasionally, children whose reflux cannot be controlled medically and who have long-term consequences of GERD, including feeding difficulty and poor weight gain, need surgery. The procedure is called Nissen fundoplication and it consists of grabbing the upper part of the stomach and wrapping it around the lower esophageal sphincter, tightening it and preventing further reflux.
