Dealing with GERD: Gastro Esophageal Reflux Disorder

By Alison Pawlikowsky

        According to Ningthoujam Sandhyarani of Buzzle.com, it is estimated that more half of infants suffer from Acid Reflux in the first three months of their lives. Gastro esophageal reflux disorder simply means acid reflux, the upward movement of the stomach content, including acid, into the esophagus and sometimes into or out of the mouth. Most of the time acid reflux in infants is caused by a poorly coordinated gastrointestinal tract. Most infants with the condition are most otherwise healthy; however, some infants can have problems affecting the brain, nerves or muscles.




The most common symptoms of GERD in infants and children:




• are frequent or recurrent vomiting
• frequent or persistent cough
• Heartburn, gas, or abdominal pain
• Colicky behavior (frequent or excessive crying and fussiness)
• Arching of the back
• Regurgitation or re-swallowing




GERD also has problems associated with it in young children such as:




• Colic
• Feeding Problems
• Recurrent choking or gagging
• Poor growth
• Breathing problems
• Recurrent wheezing
• Recurrent pneumonia




Parents provide details to doctors such as GI Specialists in order to make most diagnoses but not all are easily identified. Doctor’s do a number of tests including:




• Barium swallow or upper GI series. This is a special X-ray test that uses barium to highlight the esophagus, stomach and upper part of the small intestine. This test may identify certain problems such as any obstructions or narrowing in these areas.
• pH probe. This is currently considered the best test to diagnose reflux, but it does not always manage to detect the disease. In this test, a thin tube with a probe at the tip is placed through the nose into the esophagus. The tip, usually positioned at the lower part of the esophagus, measures levels of stomach acids. The frequency of reflux is monitored over a prolonged period of time, usually 24 hours.
• Upper GI endoscopy. During this test the doctor uses an endoscope (a thin, flexible lighted tube) to look directly inside the esophagus, stomach and upper part of the small intestine. Pinch biopsies of the esophagus obtained at the time of endoscopy may determine the presence of reflux.
• Gastric emptying study. During this test, the child drinks milk or eats food mixed with a safe radioactive chemical. This chemical is followed through the gastrointestinal tract using a special camera




Once a child is diagnosed GERD is treated by:




• Making changes in the child’s lifestyle by:
• Elevate the head of the baby's crib or bassinet
• Hold the baby upright for 30 minutes after a feeding
• Thicken bottle feedings with cereal (do not do this without a doctor's supervision)
• Change feeding schedules (discuss with the child's doctor first)
• Try solid food (discuss with the child's doctor first)




If nothing changes in a child’s condition after making these lifestyle changes medicine may be prescribed by a doctor to treat symptoms such as:




• Anti-acids such as Mylanta or Maalox
• Acid blockers such as Pepcid, Tagamet or Zantac
• Proton-Pump Inhibitors (PPI’s) such as Axid, Nexium, Prevacid and Prilosec
o These PPI’s reduce the production of acid by blocking the enzyme in the wall of the stomach that produces acid


        Medicines that decrease intestinal gas or neutralize stomach acid (antacids) are considered safe. However, at high doses, antacids can cause some side effects, such as diarrhea or constipation. Chronic use of very high doses of antacids also may be associated with an increased risk of rickets (thinning of the bones). Although serious side effects are rare, it is important to discuss with your child's doctor the pros and cons of taking a prescription medication.




Other medications used to treat GERD are those that attempt to improve coordination of the gastrointestinal tract. These include:




• Reglan. Reglan reduces symptoms of GERD by speeding up the digestion process. However, it is associated with many side effects, some of which can be serious. Reglan also can be associated with a number of drug interactions and may increase the risk of seizures in people who have seizures.
• Erythromycin. This is an antibiotic that is usually used to treat bacterial infections. It causes strong stomach contractions which eases reflux; however, this effect is not lasting.
• Propulsid. This drug was voluntarily withdrawn from the U.S. market in 2000. However, it is still available with extremely limited access. The drug works by increasing the rate that food moves through the intestines. The drug is very effective for treating childhood reflux; however, it is associated with abnormal heart rhythms.
Your child's doctor will discuss the pros and cons of these medications before prescribing them for your child.




        If your child is not gaining enough weight the doctor may suggest surgery. Surgery is not often used to treat GERD in children. When it is necessary, the Nissen Fundoplication is the most often performed surgery. During this procedure, the top part of the stomach is wrapped around the lower esophagus. This procedure forms a cuff that contracts and closes off the esophagus when the stomach contracts, preventing reflux. In some patients, a Pyloroplasty to improve gastric emptying may be performed at the same time. A Pyloroplasty is a surgical procedure in which the lower portion of the stomach, the pylorus, is cut and re-sutured to relax the muscle and widen the opening into the intestine. The Nissen fundoplication procedure is usually effective, but it is not without risk. Discuss the potential risks and benefits of this operation with your child's doctor.




        Both of my daughters were both diagnosed shortly after birth with GERD. It makes your life a lot more difficult than with a non-gerd baby. Your baby may cry and scream for hours for no apparent reason or arch their back as if they are mad. It’s very hard not being able to help your baby when you know their fed, changed, and have all their needs met. You know there’s something wrong but you just can’t tell. My first daughter never spit up, she just arched her back and kicked and screamed as if she was in pain. She was constantly fussy as if she had colic. After being so fed up from not knowing what was wrong with my baby I immediately took her to children’s hospital where she was diagnosed with GERD and immediately put on Zantac and Allimentum. She was instantly cured. No more restless and sleepless nights. My second daughter on the other hand hasn’t been so lucky, she wasn’t diagnosed with GERD until after she suffered from RSV. She still to this day constantly throws up between feedings and after. She is a constant spitter. She gets belly aches all the time but the Zantac doesn’t help. She is on Allimentum as well but I guess I am not as lucky as with my first. GERD is something sometimes you just have to deal with, it’s hard seeing your child like this but most infants grow out of GERD. Y first has grown out of it at about 6 months, once she was consistently eating baby food. My second is only 3 months old and spits up constantly, has gas and is very fussy. It can be very frustrating at times but I know one day she will grow out of it and I will have no worries so I cherish the days and nights with her as if nothing was wrong.

Works Cited

http://www.mayoclinic.com/health/gerd/DS00967/DSECTION=symptoms

http://www.buzzle.com/articles/infant-gerd-triggers-risks-and-treatment.html