Evaluation for Gastro - Esophageal Reflux Disease
What is gastro – esophageal reflux disease (GERD)?
GERD or reflux (also called gastroesophageal reflux) occurs happens when the swallowed food or liquid in the stomach flows or passes back into the throat via the food pipe called esophagus. In infants, regurgitation or spitting up is also a form of reflux. It is considered normal in most babies. It is usually resolves by one year of age. If your baby or child suffers from heartburn, pain, weight loss, and such other symptoms, then he or she might have gastroesophageal reflux disease (GERD).
What causes GERD?
When we eat or drink, it is always a one way passage with the food going down into the stomach and not passing back due to the presence of a one way gate or valve called as, lower esophageal sphincter. If this gate is unable to close completely or remains partially open, then the food and drink flows back, and when significant and associated with symptoms, leads to a disease like state called as GERD.
What increases the symptoms?
Symptoms may worsen in infants and children after large feeds or meals and when they are lying down on their back after a meal. Some medical problems could make the reflux worse, such as: •Hiatal hernias (when a part of the stomach slides up through a defect in the diaphragmatic muscle into the chest)
- Neurological disorders, such as cerebral palsy or mental retardation
- Seizure disorders
- Asthma
- Obesity
- Cystic fibrosis
What should I do to help my infant or child?
Most reflux does not require treatment. It usually resolves by the age of one year. Some tips to make your baby comfortable are:
- Burping for an adequate length of time after each feed
- Change your infant’s body positioning after feeding
- Try smaller and frequent feedings
- Thickened feeds are tolerated better. So, after the age of 6 months you could give thicker feeds.
- Have a gap of at least 2 hours between dinner and sleep time
- Avoid carbonated drinks in children
- Encourage weight loss in those who are obese
What if my baby’s symptoms get worse?
Do consult your doctor in case the symptoms are significant and the child is uncomfortable. A few tests may be advised. Some medicines may be advised which reduce the stomach acidity or reduce the reflux.
What tests are done to diagnose this condition
Diagnosis is usually clinical. To confirm the diagnosis or to rule out complications, following tests are recommended:
1: Upper endoscopy.
A thin, flexible tube equipped with a light and camera (endoscope) is passed into the food pipe and direct visualization is done. Presence of inflammation of the lower end of esophagus due to contact of the inner lining with acid reflux from stomach may be seen. Sample or biopsy may be collected to rule out complications like Barrett's esophagus.
2: Ambulatory acid (pH) probe test.
This test is done to identify and find out the severity of regurgitation.
3: Esophageal manometry
This test measures the muscle contractions in the esophagus while swallowing. It also measures the coordination and force exerted by the esophageal muscles.
4: Swallow study
Feed or milk mixed with a radio opaque dye is given to the baby and the swallowing mechanism is studied under fluoroscopy. Delayed films can detect reflux after the feed has been consumed.
5:GERD scan
It is similar to the above study. It helps to diagnose GERD and aspiration into the respiratory tract. It also helps to determine the speed of gastric emptying and is done in the Nuclear Medicine department using special camera equipment.
Can reflux be serious?
Painful or troublesome reflux which is left untreated can lead to weight loss, poor eating, and other diseases of the stomach or esophagus. So, do consult your pediatrician or pediatric pulmonologist in case your baby /child has any of the above symptoms.