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Gastroesophageal Reflux (GER)

Gastroesophageal Reflux (GER)
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Gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) are common conditions.

GER is a condition where the contents of the stomach come back up into the esophagus (food pipe). This occurs when the circular muscle at the top of the stomach (known as the lower esophageal sphincter) relaxes and creates an opening. The lower esophageal sphincter is located at the junction of the esophagus and the stomach. The sphincter relaxes when a child eats to allow food in and when a child needs to belch. In people with GER, this muscle ring also relaxes at other times. Most people experience some amount of GER. When GER becomes excessive and results in complications it is called GERD.

Symptoms of GER vary and depend on a child's age.

It is not concerning for infants to have episodes of spitting up as long as:

  • They are growing well
  • There is no blood or bile (green material) in the vomit
  • They are not having respiratory problems

Most infants outgrow GER by the age of 12 to 18 months; improvement may be noted when the infant starts to sit, stand or walk and when solid foods are begun at 6 months of age.

In older children, from toddler age to adolescents, symptoms of GER and GERD may include:

  • Chest pain
  • Heartburn
  • Refusal to eat
  • Sensation of food being stuck in the esophagus
  • Sour taste at the back of the throat
  • Vomiting

In older children, obesity can be a cause of GER/GERD.

Diagnosis of Gastroesophageal Reflux

If your older child experiences these symptoms, a pediatric gastroenterologist can perform a physical exam and additional tests to make a diagnosis, assess the severity of the problem and establish associated complications. Tests include:

  • pH tests. A pH test can determine if stomach acid is traveling into the esophagus. Types of pH tests include:
    • Esophageal pH probe (uses sensors to detect acid reflux)
    • Bravo probe (uses a wireless capsule to monitor and measure acid reflux)
    • Impedance probe study (checks for acid and non-acid reflux)
  • Upper gastrointestinal (UGI) fluoroscopy. This test will show the size and shape (known as the anatomy) of the upper gastrointestinal (GI) tract through X-ray images. It will allow the pediatric gastroenterologist to see if any obstruction or structural problems may be the cause of your child's symptoms.
  • Nuclear medicine. A gastric emptying study (a type of nuclear medicine study) measures how fast the stomach empties food.
  • Upper endoscopy. This test allows the pediatric gastroenterologist to examine the lining of the esophagus, stomach and duodenum (first part of small bowel) using a camera in a flexible tube called an endoscope. He or she will look for mucosal damage from GER or other causes leading to similar symptoms.

Treatments

Treatments

Treatment of GER and GERD depends on the age of the child and severity of the condition.

Uncomplicated GER in infants often resolves on its own or with simple behavioral changes and does not require medicine. Acid suppressing medications can increase the chance for pneumonia and gastrointestinal infections and are not routinely recommended for children under 6 months of age.

In older children and adolescents, a pediatric gastroenterologist may advise behavioral and dietary changes. Foods known to make reflux worse include:

  • Caffeine
  • Chocolate
  • Cola
  • Greasy foods
  • Peppermint
  • Spicy foods
  • Tomato-based foods

The most common things suspected to make reflux worse include:

  • Laying down after a meal
  • Overfilling the stomach
  • Tobacco smoke
  • Obesity

Your child can improve his or her symptoms by avoiding these foods and behaviors.

Children with GER disease may require medicines to treat their symptoms. Types of medicines prescribed to treat GERD include:

  • Acid blockers. Acid blockers decrease acid production in the stomach and are the most commonly prescribed medicines for GERD. Acid blockers include:
    • Ranitidine (Zantac®)
    • Nizatidine (Axid®)
    • Omeprazole (Prilosec®)
    • Lansoprazole (Prevacid®)
    • Esomeprazole (Nexium®)
    • Pantoprazole (Protonix®)

If medicines do not ease symptoms and promote healing, a pediatric gastroenterologist may discuss surgical options.

Key Points to Remember

Key Points to Remember

  • GER generally resolves on its own in infants.
  • Children older than 2 years old who routinely spit up or vomit need further evaluation.
  • Medicines can help your child feel better but are not needed for uncomplicated infant reflux

Support Services & Resources

Support Services & Resources

Visit the websites below to find support groups and services and learn more about GER.

We offer a broad range of supportive services to make life better for families who choose us for their children's care.

Learn More About Riley Support Services

GIKids

This website from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition explains the differences between GERD in infants and GERD in older children and offers resources and checklists to help manage the condition.

Gastroesophageal Reflux (GER) Research

Gastroesophageal Reflux (GER) Research

The pediatric gastroenterologists at Riley at IU Health participate in clinical research to advance the understanding of esophageal diseases, including GERD. You and your child may be offered participation in our research studies. These studies may help improve our care of children with similar problems. We encourage you to ask plenty of questions in order to make an informed decision.

Locations

Locations

Locations

In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.

Sort through 7 facilities offering Gastroesophageal Reflux (GER) care by entering your city or zip below.

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Departments Treating This Condition

Departments Treating This Condition

  • Gastroenterology, Hepatology & Nutrition
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Designated as Best Children's Hospitals by U.S. News & World Report, Ranked in 10 Specialties in 2023-24

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