Gastroesophageal reflux disease (GERD), gastro-oesophagealreflux disease (GORD), gastric reflux disease, or acidreflux disease is defined as chronic symptoms or mucosal damageproduced by the abnormal reflux in the oesophagus.
This is commonly due to transient or permanent changes in the barrierbetween the oesophagus and the stomach. This can be due to incompetence of the lower esophageal sphincter, transientlower oesophageal sphincter relaxation, impaired expulsion of gastric refluxfrom the oesophagus, or a hiatus hernia. Respiratory and laryngealmanifestations of GERD are commonly referred to as extraesophageal reflux disease(EERD).
Signs and symptoms
The most-common symptoms of GERD are:
Less-common symptoms include:
- Pain with swallowing (odynophagia)
- Excessive salivation (this is common during heartburn, as saliva is generally slightly basic and is the body's natural response to heartburn, acting similarly to an antacid)
- Chest pain
GERD sometimes causes injury of the esophagus. These injuries may include:
Several other atypical symptoms are associated with GERD, but there is goodevidence for causation only when they are accompanied by esophageal injury.These symptoms are:
Some people have proposed that symptoms such as pharyngitis,sinusitis,recurrent ear infections, and idiopathic pulmonary fibrosis are dueto GERD; however, a causative role has not been established.
GERD may be difficult to detect in infants and children. Symptomsmay vary from typical adult symptoms. GERD in children may cause repeated vomiting,effortless spitting up, coughing, and other respiratory problems. Inconsolable crying,failure to gain adequate weight, refusing food, bad breath, and belching or burpingis also common. Children may have one symptom or many — no single symptom isuniversal in all children with GERD.
Common symptoms of Pediatric Reflux
- Irritability and pain, sometimes screaming suddenly when asleep. Constant or sudden crying or “colic” like symptoms. Babies can be inconsolable especially when laid down flat.
- Poor sleep habits typically with arching their necks and back during or after feeding
- Excessive possetting or vomiting
- Frequent burping or frequent hiccups
- Excessive dribbling or running nose
- Swallowing problems, gagging and choking
- Frequent ear infections or sinus congestion
- Babies are often very gassy and extremely difficult to “burp” after feeds
- Refusing feeds or frequent feeds for comfort
- Night time coughing, extreme cases of acid reflux can cause apnoea and respiratory problems such as asthma, bronchitis and pneumonia if stomach contents are inhaled.
- Bad breath – smelling acidy
- Rancid/acid smelling diapers with loose stool. Bowel movements can be very frequent or babies can be constipated.
Possetting after a feed is quite normal with most infants. They gainweight, feed well and have no other symptoms, but still this can be upsettingfor parents. As the child gets older the lower oesophageal sphincter becomesmore competent so the vomiting should begin to show signs of improvement andeventually stop. Some babies suffer more with reflux and about 60% of thesebabies with persistent reflux may have weight gain issues. It is a very popular misconceptionthough that all babies and children with reflux are underweight. This isn't always the case, some maycomfort eat and feed very frequently and not all are sick. Many doctorsadvise that babies outgrow reflux once they can sit up, or once they stand.Many do, but some will not only fail to outgrow it, but will noticeably worsenwith developmental milestones, teething episodes, viral illness and weaning.
Some babies with reflux do not vomit at all. This is actually more of aproblem because the acidic stomach contents go up the throat and back downagain, causing twice the pain and twice the damage. There is no clearrelationship between symptoms and the severity of reflux.
It is estimated that of the approximately 4 million babies born in the U.S.each year, up to 35% of them may have difficulties with reflux in the first fewmonths of their life, known as spittingup. Most of those children will outgrow their reflux by their firstbirthday. However, a small but significant number of them will not outgrow thecondition. This is particularly true where there is a family history of GERDpresent.
GERD may lead to Barrett's esophagus, a type of metaplasiawhich is in turn a precursor condition for carcinoma. The risk of progressionfrom Barrett's to dysphasia is uncertain but is estimated at about 20% ofcases. Due to the risk of chronic heartburn progressing to Barrett's, EGD every5 years is recommended for patients with chronic heartburn, or who take drugsfor chronic GERD.