Gastroesophageal Reflux Disease (GERD)

When food is swallowed it passes thru the food pipe (esophagus) to the stomach. A muscle at the end of the esophagus closes to prevent the food from moving backwards into the esophagus. If this muscle doesn’t close well, food, liquid and stomach acid can leak back into the esophagus. This can irritate the esophagus and causes gastroesophageal reflux (GERD) signs and symptoms.

Most people have heartburn from time to time and manage it with over-the-counter medications and changes in their life style. When signs and symptoms occur at least twice a week or interfere with daily life it could be GERD. GERD signs and symptoms include:

  • A burning sensation in the chest (heartburn), sometimes spreading to the throat, along with a sour taste in the mouth
  • Chest pain
  • Difficulty swallowing (dysphagia)
  • Dry cough
  • Hoarseness or sore throat (especially in the morning)
  • Acid reflux (regurgitation)
  • Sensation of a lump in the throat.

GERD affects 25-40% of adults in the US to some degree. About 10% of adults have GERD daily or weekly. Infants and children can also have GERD. It is often normal in infants when they spit up or vomit. Most cases stop by 12 months of age. If the problem doesn’t stop, a medication or referral to a gastroenterologist may be necessary.

Symptoms of reflux disease in infants (0-24 months old) include:

  • Vomiting associated with blood, green or yellow fluid, or poor weight gain.
  • Colic (frequent crying and fussiness)
  • Baby refuses to eat causing poor growth or failure to thrive
  • Difficulty eating (recurrent choking or gagging)
  • Breathing problems (wheezing, pneumonia)
  • Recurrent ear infections (otitis media)

For older children, GERD symptoms can be similar to adults. The most common is heartburn. The pain or discomfort usually starts in the middle of the chest and can move up through the throat. Heartburn can be frequent, constant, and/or severe.

Other common symptoms of GERD in children include:

  • Feeling like the food is stuck in the throat
  • Feeling like they are choking or the throat is tight
  • Acidic or sour taste in the mouth (acid indigestion)
  • Difficult or painful swallowing
  • Chest pain

Risk Factors for GERD

A risk factor is something that increases your likelihood of getting a disease or condition. The more risk factors you have, the greater likelihood of developing GERD:

  • Obesity
  • Hiatal hernia
  • Pregnancy
  • Diabetes
  • Asthma
  • Connective tissue disorders
  • Zollinger-Ellison syndrome

Foods can trigger reflux in some people. Common foods that worsen symptoms include:

  • Onions
  • Tomato sauce
  • Mint
  • Carbonated drinks,
  • Chocolate
  • Foods containing caffeine
  • Spicy foods and foods with high fat content.

Some medications and dietary supplements may worsen GERD symptoms:

  • Sedatives
  • Tranquilizers
  • Antidepressants
  • Calcium channel blockers
  • Narcotics
  • NSAIDs
  • Iron, potassium, vitamin C

Diagnosis/Testing

The gastroenterologist may test to confirm GERD:

  • Upper GI series (barium swallow)
  • Upper GI endoscopy (Esophagogastroduodenoscopy or EGD)
  • Esophageal manometry
  • 24-hour pH probe study
  • A positive stool occult blood test to see if there is bleeding from esophagus, stomach, or intestines.

Treatment

Treatment for heartburn and other signs and symptoms of GERD start with over-the-counter medications. If there is no relief after a few weeks, the doctor may recommend other medications, or surgery.

Over-the-counter medicines that treat heartburn include:

  • Antacids – like Maalox, Mylanta, Gelusil, Rolaids, Tums
  • Medicines that reduce acid production – like Tagamet HB, Pepcid AC, Axid AR, Zantac
  • Medicines that block acid production and heal esophagus – like Prevacid 24 Hr, omeprazole

Prescription-strength drugs:

  • H-2 receptor blockers – like Tagamet, famotidine (Pepcid), nizatidine (Axid) and ranitidine (Zantac)
  • Proton pump inhibitors – like esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex) and dexlansoprazole (Dexilant).
  • Medicines to strengthen the lower esophageal muscle (sphincter).

Surgery and other procedures used if medications do not help:

  • Surgery to reinforce the lower esophageal muscle (sphincter)
  • Surgery to create a barrier preventing the backup of stomach acid
  • A procedure to form scar tissue in the esophagus.

Life-style changes for infants and children:

Infants:

  • Elevate the head of the baby’s crib or bassinet
  • Hold the baby upright for 30 minutes after feeding
  • Thicken bottle feeding with cereal
  • Change feeding schedules
  • Try solid food

Children:

  • Elevate the headboard
  • Keep child upright for at least 2 hrs after eating
  • Several smaller meals throughout the day
  • Encourage child to get regular exercise
  • Avoid non-steroidal anti-inflammatory or aspirin-containing medications.

One of our dieticians is available for a nutritional consult to make dietary changes. Call (865) 546-3998 to schedule an appointment.

*Please see the “Nutrition” section of this website for further information.