Gastroesophageal Reflux Disease -- Adolescent

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(GERD—Adolescent; Chronic Heartburn—Adolescent; Reflux Esophagitis—Adolescent; Gastro-oesophageal Reflux Disease—Adolescent; GORD—Adolescent; Heartburn—Adolescent; Reflux—Adolescent)

Definition

Gastroesophageal reflux disease (GERD) is a disorder that results from food and stomach acid backing up into the esophagus from the stomach. GERD is different from gastroesophageal reflux (GER). GER is a common disorder seen in infants, which causes them to spit up. Most infants outgrow GER within 12 months.

This condition can cause serious health issues. Treatment for GERD includes lifestyle changes, medications, and sometimes surgery.

Gastroesophageal Reflux Disease

Causes

Food travels down the esophagus to the stomach. The opening between the esophagus and stomach opens to let food enter the stomach. Normally, it closes as soon as the food enters the stomach. With GERD, the opening does not close tightly. Stomach acid flows into the esophagus, called acid reflux, causing a burning sensation.

The following factors contribute to GERD:

Abnormal pressure to the lower esophageal sphincter (LES), a valve that keeps food in the stomach
Increased relaxation of LES
Increased pressure within the abdomen

Risk Factors

The following may increase the risk of GERD in adolescents:

Symptoms

If your teen has any of these symptoms, do not assume it is due to GERD. These symptoms may be caused by other conditions.

Symptoms may include:

Heartburn
Regurgitation
Abdominal or chest pain
Vomiting
Difficulty swallowing
Dry cough
Raspy voice
Sore throat
Recurrent pneumonia or worsening asthma
Weight loss, lack of appetite

Diagnosis

Your doctor will ask about your teen’s symptoms and medical history. A physical exam will be done.

Tests may include:

Upper GI series —a series of x-rays of the upper digestive system taken after drinking a barium solution
Upper endoscopy with biopsy—a tube is inserted into esophagus to look at the lining and a piece of tissue is taken for testing
24-hour pH monitoring—a probe is placed in the esophagus to keep track of the level of acidity in the lower esophagus
Short trial of medication

Treatment

Talk with your teen's doctor about the best treatment plan. Treatment options include the following:

Lifestyle Changes

Before recommending medication, your teen's doctor may suggest lifestyle changes. These may include:

Eating smaller, more frequent meals
Avoiding late night snacks
Sleeping with the head of the bed elevated
Lose weight
Quit smoking
Avoid alcohol

Foods to avoid may include:

Chocolate
Fried foods
Peppermint
Spicy foods
Caffeine products
Carbonated beverages
Foods high in fat and acid

Medications

Medication will help relieve symptoms and heal any damage to the esophagus. Many medications for GERD are available over-the-counter and by prescription. Your teen's doctor may recommend the following:

Antacids
H-2 blockers
Proton pump inhibitors

Procedures

In more severe cases, the doctor may recommend surgery or endoscopy. The most common surgery is called fundoplication. During this procedure, the surgeon wraps part of the stomach around the lower esophageal sphincter. This makes the sphincter stronger and prevents stomach acid from backing up into the esophagus. In many cases, this procedure can be done through small incisions in the skin, called laparoscopy.

Prevention

There are no guidelines to prevent GERD.

RESOURCES

Children’s Digestive Health and Nutrition Foundation http://cdhnf.org

National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov

CANADIAN RESOURCES

About Kids Health http://www.aboutkidshealth.ca

Canadian Digestive Health Foundation http://www.cdhf.ca

References

Gastroesophageal reflux disease (GERD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated April 29, 2013. Accessed April 30, 2013.

Gastroesophageal reflux disease (GERD). Nemours Teen's Health website. Available at: http://kidshealth.org/teen/diseases%5Fconditions/digestive/gerd.html. Updated June 2011. Accessed April 30, 2013.

Gastroesophageal reflux in children and adolescents. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gerinchildren/index.htm. Updated February 21, 2012. Accessed April 30, 2013.

GERD in children and adolescents. Children’s Digestive Health and Nutrition Foundation website. Available at: http://gerd.cdhnf.org/User/Docs/PDF/AdolesGERDFlier.pdf . Accessed May 19, 2008.

Pediatric gastroesophageal reflux, clinical practice guideline summary. Children’s Digestive Health and Nutrition Foundation website. Available at: http://gerd.cdhnf.org/User/Docs/PDF/GERD%5F8%5Fpg%5Fbrochure%5F031604.pdf . Accessed May 19, 2008.

Pediatric GE reflux clinical practice guidelines. J Pediatr Gastroenterol Nutr. 2001;32:S1-S31.

Transoral incisionless fundoplication with EsophyX. Endogastric Solutions website. Available at: http://www.endogastricsolutions.com/esophyx%5Ffor-pt.htm . Accessed August 19, 2009.

3/1/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Maalox Total Relief and Maalox liquid products: medication use errors. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm200672.htm. Published February 17, 2010. Accessed April 30, 2013.

Revision Information

Reviewer: Daus Mahnke, MD; Brian Randall, MD
Review Date: 04/2013 -
Update Date: 04/30/2013 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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