Gastroesophageal Reflux Disease (Acid Reflux)
Gastroesophageal reflux disease (GERD) occurs when simple gastroesophageal reflux (GER) causes a problem. Most babies with spilling don't have GERD, they just have simple reflux which is of no concern.
This page contains information on reflux disease which is sometimes referred to as acid reflux. In simple reflux, the stomach acid is neutralised by the milk so it doesn't cause a problem, but in GERD, acid can be a problem - read on to find out more.
What is GERD?
Gastroesophageal Reflux Disease (GERD) is what happens when simple gastroesophageal reflux becomes problematic. It is often referred to as acid reflux in infants.
Some vomiting (or reflux) in babies is normal - to read more on simple gastroesophageal reflux, click here.
Reflux becomes problematic when:
- it interferes with growth (mainly weight gain)
- acid is burning the lower end of the esophagus as it refluxes up from the stomach
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Why is acid reflux a problem?
Usually if a baby vomits a feed, she vomits milk which will dilute any stomach acid coming up the esophagus, so there is no damage from any acid. However, if there is a lot of acid coming up the esophagus that is not diluted, it can burn the esophagus, particularly at the lower end.
If the acid continues burning the esophagus over a long time, this can cause damage to the cells of the esophagus and in the long-term (in adult life) this could even lead to cancer. We don't want acid reflux in infants or toddlers causing damage to the esophagus.
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Can toddlers have acid reflux?
Yes, they can although it is less common than acid reflux in babies. The symptoms would include discomfort after eating and/or with lying flat. They may also have vomiting.
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How is gastroesophageal reflux disease (GERD) diagnosed?
Gastroesophageal Reflux Disease is diagnosed from the story of the vomiting and the associated symptoms of acid reflux - in infants this would include discomfort or distress with vomiting or with lying flat. There are also tests that can show Gastroesophageal Reflux Disease.
- A Barium Swallow is a test where the baby is given Barium (a white chalky liquid) to drink - it shows up on x-ray and so we can see if the barium comes back up the esophagus after it reaches the stomach. The test will also show a hiatus hernia (a condition where part of the stomach is pulled up above the diaphragm). A Barium swallow will not tell us if there is acid coming up that is burning the esophagus, though. It is best used to look at the anatomy of the gut and for any problems with esophageal motility. So it is not good for diagnosing acid reflux in infants or toddlers but does show if there is any reflux.
- There is also a test called a pH study - this measures the acid at the base of the esophagus. It should not be very acid at the base of the esophagus for very long (whereas the stomach is acid). If the pH is less than 4 (acid) for more than 4% of the time we are measuring, this is abnormal and would indicate gastro-esophageal reflux disease (GERD) or acid reflux in infants or toddlers. We usually measure the pH for at least a 24 hour period. We ask the mother to indicate when her baby is having symptoms and we can check what the pH was at that time to know if acid is the cause. A pH study is particularly useful if silent reflux is a possible diagnosis.
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What is the treatment of Gastroesophageal Reflux Disease?
First, make sure you do all the simple things we advise for simple gastroesophageal reflux like positioning, thickening the feeds or Gaviscon if necessary - read more on simple measures for gastroesophageal reflux.
Specific treatments for gastroesophageal reflux disease depend on the symptoms that are most worrying.
- When acid reflux in infants is the problem, the treatment is an acid-suppression medication like:
These medications will not necessarily stop vomiting but they will stop the acid and so protect the esophagus.
- If vomiting is a big problem causing poor growth, the first medication to try would be Gaviscon to see if that works - it puts a gel coating over the milk in the stomach - read more. If that doesn't work, there are some medications that might help by emptying the stomach quickly (so there is not so much milk to reflux). These medications, which are called prokinetic agents and include Metoclopramide, Domperidone and the antibiotic Erythromycin, can have side effects so you will need medical supervision. In the past a medication called Cisapride was used to empty the stomach in reflux - it was then found to have serious side effects and so it is no longer used.
- There is a surgical procedure, called a Nissen's fundoplication, which is sometimes used in severe cases of acid reflux in infants and toddlers.
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What is the treatment of silent reflux?
Silent reflux is when there is no vomiting, so the GERD isn't obvious, but there is reflux of acid from the stomach into the lower esophagus that causes burning and pain - this acid reflux in babies causes them to cry and often arch their backs in pain.
Silent reflux can be confirmed with a pH study. The treatment is anti-acid medication like Ranitidine (Zantac) or Omeprazole.
Sometimes, if silent reflux is considered the problem, a trial of an anti-acid medication like Ranitidine or Omeprazole is given to see if symptoms improve. If acid is the problem, the symptoms should improve.
If the symptoms do not improve with anti-acid medication, it is probably because silent acid reflux is not the problem. Babies of 1-4 months of age can have colic and anti-acid medication will not help colic - read more.
If it is not clear what the problem is, it is best to have a pH study, which will show whether acid reflux is causing the symptoms.
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Kumar & Sarvananthan. Gastro-oesophageal reflux in children. Clinical Evidence, BMJ Publishing Group. May 2006.
To go to the top of the Gastroesophageal Reflux Disease page, click here
To go to the Gastroesophageal Reflux page, click here
To read about Zantac use in GERD, click here
To read about Omeprazole (Prilosec), click here
To read more on Gaviscon, click here
To go to the Colic page, click here
To go to the Vomiting page, click here
To go to the Newborn Baby problem page, click here
To go to the Home page, click here
Last reviewed 26 May 2011