Signs and Symptoms and Diagnosis for Teens

Gastroesophageal Reflux (GER) occurs when stomach contents go up into the esophagus (the tube that connects the mouth to the stomach), during or after a meal. In some children, the stomach contents go up the mouth (regurgitation) and are swallowed again. Other symptoms include hoarseness, recurrent pneumonia, cough, wheezing and difficulty or painful swallowing.

The doctor or nurse can talk with you about your child’s symptoms, do a physical examination and recommend tests to determine if reflux is the cause of symptoms. These tests check the esophagus, stomach and small intestine to see if there are any problems. However, treatment is sometimes started without the need for any tests. Common tests are:

* Barium (a chalky drink) is swallowed and X-rays show the shape of the esophagus and stomach. This test can find a hiatal hernia, blockage and other problems.
* Endoscopy: After the patient is given a sedative medication so they are asleep, a small flexible tube with a very tiny camera is inserted through the mouth and down into the esophagus and stomach. The lining of the esophagus, stomach and part of the small intestine can be examined and biopsies (small pieces of the lining) can be painlessly obtained. The biopsies can later be examined with a microscope, looking for inflammation and other problems
* Esophageal pH Probe: A thin light wire with an acid sensor at its tip is inserted through the nose into the lower part of the esophagus. The probe can detect the amount of stomach acid coming up into the esophagus and can tell if there acid in the esophagus.

Worrisome Symptoms of Reflux Disease in Children

(2 - 12 Years Old) (Symptoms experienced by your child.)
1. Repeated vomiting associated with
Blood
Green or yellow fluid
Weight loss or poor weight gain

2. Frequent sensation of food or liquid coming up into the back of the throat or mouth

3. Frequent discomfort in the stomach or chest

4. Swallowing problems
* Discomfort with the act of swallowing
* Pain with swallowing
* Sensation that food gets stuck on the way down

5. Breathing Problems
* Wheezing
* Chronic cough or recurrent pneumonia
* Hoarseness
* Asthma

If you have concerns, speak to your healthcare provider.

WHAT’S UP WITH MY KID’S STOMACH?

Reflux and your Child (2 -12 year olds)
Gastroesophageal Reflux (GER) occurs during or after a meal when stomach contents go back into the tube that connects the mouth to the stomach. Most children are able to decrease their reflux with lifestyle and diet changes:

* Have your child eat smaller meals more often
* Avoid eating 2 to 3 hours before bed time
* Avoid carbonated drinks, chocolate, caffeine, and foods that are high in fat (french fries and pizza) or contain a lot of acid (citrus, pickles, tomato products) or spicy foods.
* Avoid large meals prior to exercise
* Help your child lose weight if they are overweight
* Avoid exposure to tobacco smoke
*
Elevate the head of the bed 30 degrees

Most children with GER will be helped with the treatment mentioned above. If symptoms are severe or persistent then your primary care provider may consider treatment with a medication or referral to a pediatric gastroenterologist.

Psychosocial Issues

Ger and GERD obviously have consequences for the children so afflicted, however an often overlooked consequence is what happens to the primary caregiver. If treatment for the conditions is ineffective or the children go untreated it is likely that the patient’s condition will lead to some level discomfort for the primary caregiver(s). Pediatric GERD caregivers are likely to experience report sleep loss and some level of psychological and physical stress as a result of ineffective or inadequate treatment of GERD. The effect on the caregiver can be profound and affect all aspects of their normal routine from sleep, and professional activities to family relationships and normal social interactions.

Medical Therapy

The treatment of reflux depends upon the infant’s symptoms and age. Some babies may not need any treatment, as GER can resolve in many cases without treatment. Healthy, happy babies may only need the feedings thickened with cereal and to be kept upright after they are fed. Over feeding can aggravate reflux, and your health care provider may suggest different ways of handling the problem. For example, smaller volume with more frequent feeding can help decrease the chances of regurgitating. If a food allergy is suspected they may ask you to change the baby’s formula (or modify the mother’s diet if the baby is breastfed) for one to two weeks. If a child is not growing well, feedings with higher calorie content or tube feeding may be recommended.

1.

When a child is uncomfortable, or has difficulty sleeping, eating or growing, the doctor or nurse may suggest a medication. Different types of medicine can be used to treat reflux by decreasing the acid secreted by the stomach. One class of these medications is the H2-blockers such as cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid) and nizatidine (Axid). Another type of medication is the proton-pump inhibitors such as esomeprazole (Nexium), omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex) and pantoprazole (Protonix).

2.

Very rarely do infants have severe GER that prevents them from growing or cause breathing problems. In some of these infants, surgery may be the best option.

Diet Nutrition and Lifestyle

Gastroesophageal Reflux (GER) occurs during or after a meal when stomach contents go back into the tube that connects the mouth to the stomach. GER occurs often in normal infants. Most infants with GER are happy and healthy even though they spit up or vomit. Spitting up tends to peak at 4 months and most infants stop spitting up by 12 months of age. If your baby is spitting up without discomfort and is making appropriate weight gains, then he or she is probably a normal spitter. Things that you can do at home to help reduce spitting up:

Avoid overfeeding

1.	Don't feed the baby again after he or she spits up - wait until the next feeding.
2.	Consult your doctor to see if the baby is taking appropriately sized bottles or nursing the appropriate amount of time. For formula fed infants, feedings can be thickened
3.	For formula fed infants, try a hypoallergenic formula for 2 weeks
4.	Keep infant upright for at least 30 minutes after meals
5.	Avoid car seat positioning in the home Avoid tight diapers and elastic waistbands
6.	Avoid exposure to tobacco smoke

Most infants with GER will be helped with the treatment mentioned above. If symptoms are severe or persistent then your primary care provider may consider treatment with a medication or referral to a pediatric gastroenterologist.

Signs and Symptoms and Diagnosis for Infants

Gastroesophageal Reflux (GER) occurs when stomach contents come go into the esophagus (the tube that connects the mouth to the stomach), during or after a meal. Most infants with GER are happy and healthy even though they spit up or vomit. An infant with GER may experience:

• Spitting
• Vomiting
• Coughing
• Irritability
• Poor feeding
• Blood in the stools

GER occurs often in normal infants. More than half of all babies experience reflux in the first 3 months of life. Only a small number of infants have symptoms due to GER. Most infants stop spitting up between the ages of 12 to 18 months.
In a small number of babies, GER may result in symptoms that are concerning. These include problems such as

• Poor growth due to an inability to hold down enough food
• Irritability or feeding refusal due to pain
• Blood loss from acid burning the esophagus
• Breathing problems

Each of these problems can be caused by disorders other than GER. Your health care provider needs to determine if GER is causing your child’s

For more information click on the links below go to the Patients and Parents site and check out the resources on Infant GER below

Genetics

In the past several years, there have been a number of research studies suggesting that GERD may be an inherited disease. In 2004 CDHNF kicked-off Family GERD Week with the release of findings from a survey of 200 pediatricians and family practitioners to determine their understanding of the possible genetic basis for GERD.

It revealed that 89 percent of the physicians surveyed believe that GERD may be an inherited condition, and over 70 percent of respondents also recognize that serious complications from heartburn, such as erosive esophagitis, Barrett’s esophagus and esophageal cancer, also likely have an inherited basis. However, only 48 percent of respondents routinely inquire about family history. The survey clearly showed that while the genetic relationship of these diseases is still being studied, it is necessary for physicians to be more cognizant of family history when diagnosing patients with GERD.

Heartburn and Indigestion during Pregnancy

Many women have heartburn for the first time during pregnancy, particularly during the second and third trimesters. Although this is not usually a sign of a serious problem, it can be uncomfortable or painful.

Heartburn occurs when digested food from your stomach, which contains acid, is pushed up toward your esophagus. This causes a burning sensation behind your breastbone or a burning sensation that starts in your stomach and seems to rise up. You may also have a sour taste in your mouth or a feeling that vomit is rising in your throat.

Normally, food moves down a pipe (called the esophagus) between your mouth and your stomach. When you're not eating, a circular valve around the bottom of your esophagus closes off the connection between your esophagus and your stomach. This valve keeps the acids in your stomach from rising up.

When you swallow, the valve relaxes to allow food and liquid to flow through. If the valve relaxes when you're not eating, the acids from your stomach can flow back up into your esophagus, irritating it and causing a burning sensation.

Several things can cause the valve to relax more easily, such as:

• Greasy or fatty foods
• Chocolate or drinks containing caffeine
• Onions, garlic or spicy foods
• Certain medications
• Eating a very large meal
• Lying down after eating

During pregnancy, hormones relax the muscles in your digestive tract, including the valve in the esophagus. This allows stomach acids to more easily seep back up the esophagus, especially when you're lying down. Heartburn can be worse in the second and third trimesters, when your growing uterus presses on your stomach. This sometimes pushes food back up into the esophagus.

Pregnancy hormones also slow down:

• muscles that push food from your esophagus into your stomach
• muscles that contract to digest food in your stomach, which slows down your digestion

These changes can also lead to indigestion, which can make you feel very full, bloated or gassy.

When to seek medical advice

Most problems with heartburn are fleeting and mild. But if you have severe or frequent discomfort, you may be developing complications that need more intensive medical treatment and prescription medications. Talk to your doctor if you have:

• Heartburn several times a week
• Heartburn that returns soon after your antacid wears off
• Heartburn that wakes you up at night

You may need further medical care, possibly even surgery, if you experience any of these:

• Symptoms that persist even though you're taking prescription heartburn medications
• Difficulty swallowing
• Regurgitated blood or black material
• Stool that's black
• Weight loss

Risk factors

Conditions that cause difficulty with digestion can increase the risk of heartburn. These include:

• Obesity
• Excess weight puts extra pressure on your stomach and diaphragm — the large muscle that separates your chest and abdomen — forcing open the lower esophageal sphincter and allowing stomach acids to back up into your esophagus. Eating very large meals or meals high in fat may cause similar effects.
• Hiatal hernia
  
• If this protrusion of part of your stomach into your lower chest is large, it can worsen heartburn by further weakening the lower esophageal sphincter muscle.
• Pregnancy
  
• Pregnancy results in greater pressure on the stomach and a higher production of the hormone progesterone. This hormone relaxes many of your muscles, including the lower esophageal sphincter.
• Asthma
  
• Doctors aren't certain of the exact relationship between asthma and heartburn. It may be that coughing and difficulty exhaling lead to pressure changes in your chest and abdomen, triggering regurgitation of stomach acid into your esophagus. Some asthma medications that widen (dilate) airways may also relax the lower esophageal sphincter and allow reflux. Or it's possible that the acid reflux that causes heartburn may worsen asthma symptoms. For example, you may inhale small amounts of the digestive juices from your esophagus and pharynx, damaging lung airways.
• Diabetes
  
• One of the many complications of diabetes is gastroparesis, a disorder in which your stomach takes too long to empty. If left in your stomach too long, stomach contents can regurgitate into your esophagus and cause heartburn.
• Gastric outlet obstruction
  
• This is a partial blockage caused by scarring, an ulcer or a growth near the valve (pylorus) in the stomach that controls the flow of food into the small intestine. It can keep this valve from working properly or can obstruct the release of food from the stomach. Food doesn't empty from your stomach as fast as it should, causing stomach acid to build up and back up into your esophagus. This usually causes more signs and symptoms than just heartburn, such as abdominal pain, difficulty eating, weight loss, nausea and vomiting. If you experience any of these signs and symptoms, consult your doctor.
• Delayed stomach emptying
  
• In addition to diabetes or an ulcer, abnormal nerve or muscle functions can delay emptying of your stomach, causing acid backup into the esophagus. Medications may also lead to delayed stomach emptying. These include narcotics, some antidepressants and antihistamines.
• Connective tissue disorders. Diseases such as scleroderma that cause muscular tissue to thicken and swell can keep digestive muscles from relaxing and contracting as they should, allowing acid reflux.
• Zollinger-Ellison syndrome. One of the complications of this rare disorder is that your stomach produces extremely high amounts of acid, increasing the risk of acid reflux.

Chronic Reflux Often Leads to Sleepless Nights

HealthDay

By Robert Preidt

Thursday, October 18, 2007

THURSDAY, Oct. 18 (HealthDay News) -- Along with typical symptoms such as acid reflux, the less typical symptoms of gastroesophageal reflux disease (GERD) -- such as coughing, choking, wheezing, choking, snoring, sore throat, and chest pain -- can cause people significant sleep problems, according to a new U.S. survey.

The poll of 701 GERD patients found that sleep impairment was much more common among those with GERD (41.9 percent) than among people without GERD (19.4 percent), and that about half of people with nighttime GERD reported sleeping poorly often or most of the time, compared to 36.7 percent of those with daytime GERD.

Among GERD patients, 74 percent reported at least one nighttime atypical symptom. For almost every atypical symptom in the study, more than 20 percent of GERD patients reported that the symptom occurred frequently -- more than two nights a week.

The survey also found that GERD patients with atypical symptoms were more likely to suffer sleep problems than GERD patients with typical symptoms such as heartburn and acid regurgitation.

The percentage of GERD patients who reported sleeping problems was much higher for those reporting eight out of nine of the atypical symptoms included in the survey than for these without atypical symptoms.

The findings were presented this week at the annual scientific meeting of the American College of Gastroenterology, in Philadelphia.

Know the Symptoms of Acid Reflux In Babies

It’s very frustrating to be a parent or caregiver whose baby is upset and crying if you don’t know what is wrong. Your infant does not have any other way to communicate yet, so crying is the main sign of hunger or discomfort. Learning about all the various issues that the average baby or toddler may suffer from can help, however, as the more you know, the more you can help your child to feel better. One subject that many parents and caregivers don’t know much about is how to recognize the symptoms of acid reflux in babies.

Yes, even tiny infants can suffer from acid reflux. In fact, it’s quite common, as the digestive symptom in infants is not yet fully developed. They also have no capacity yet to tell when they are full, nor to communicate this to their caregivers. What this means is that babies cannot always keep the foods and liquids they’ve been fed inside their stomachs. In addition, most infants spend a majority of their time lying down, which, as any adult sufferer of acid reflux will tell you, only aggravates the symptoms of acid reflux. In babies this is no different, so if your child seems to be suffering from acid reflux-related discomfort, try putting him or her in a seat or carrier that allows an upright position for a larger portion of the day.

It is very important to know the symptoms of acid reflux in babies, as failing to deal with them can lead to failure to thrive, due to the baby not getting enough nutrition. Allowing the esophagus to be continually exposed to the stomach acids can also lead to tissue damage or even scarring, and possibly to breathing problems later in life.

But it can be difficult to tell the difference between normal infant vomiting & crankiness and the more serious symptoms of acid reflux in babies. It’s perfectly normal for babies to spit up their food, due to the same immaturity of the digestive system that causes the symptoms of acid reflux in babies in the first place. And since they cannot yet communicate, they are unable to express just why they may be feeling uncomfortable or even in pain. If your infant’s vomiting seems to be occurring after every meal, or if he or she is also having breathing difficulties, you should consider that these might be symptoms of acid reflux, and see your pediatrician.

Treatment of the symptoms of acid reflux in babies may range from simply feeding your baby different foods and adjusting his or her sleeping conditions to prescription medications. Whatever treatment your doctor prescribes, be sure to follow instructions carefully, as symptoms of acid reflux in babies can quickly lead to more serious conditions.