Acid Reflux (Gastroesophageal reflux)

Gastroesophageal reflux disease (GERD), gastro-oesophageal reflux disease (GORD), gastric reflux disease, or acid reflux disease is defined as chronic symptoms or mucosal damage produced by the abnormal reflux in the esophagus.

This is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach. This can be due to incompetence of the lower esophageal sphincter, transient lower esophageal sphincter relaxation, impaired expulsion of gastric reflux from the esophagus, or a hiatal hernia. Respiratory and laryngeal manifestations of GERD are commonly referred to as extraesophageal reflux disease (EERD).

Signs and symptoms

Adults

The most-common symptoms of GERD are:

• Heartburn
• Regurgitation
• Trouble swallowing (dysphagia)

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)
• Nausea
• Chest pain

GERD sometimes causes injury of the esophagus. These injuries may include:

• Reflux esophagitis—necrosis of esophageal epithelium causing ulcers near the junction of the stomach and esophagus.
• Esophageal strictures—the persistent narrowing of the esophagus caused by reflux-induced inflammation.
• Barrett’s esophagus—metaplasia (changes of the epithelial cells from squamous to columnar epithelium) of the distal esophagus.
• Esophageal adenocarcinoma—a rare form of cancer.

Several other atypical symptoms are associated with GERD, but there is good evidence for causation only when they are accompanied by esophageal injury. These symptoms are:

• Chronic cough
• Laryngitis (hoarseness, throat clearing)
• Asthma
• Erosion of dental enamel
• Dentine hypersensitivity
• Sinusitis and damaged teeth^[4]

Some people have proposed that symptoms such as pharyngitis, sinusitis, recurrent ear infections, and idiopathic pulmonary fibrosis are due to GERD; however, a causative role has not been established.^[3]

Children

GERD may be difficult to detect in infants and children. Symptoms may 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 burping are also common. Children may have one symptom or many — no single symptom is universal 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.

Vomiting feeds

Possetting after a feed is quite normal with most infants. They gain weight, feed well and have no other symptoms, but still this can be upsetting for parents. As the child gets older the lower oesophageal sphincter becomes more competent so the vomiting should begin to show signs of improvement and eventually stop. Some babies suffer more with reflux and about 60% of these babies with persistent reflux may have weight gain issues. It is a very popular misconception though that all babies and children with reflux are underweight. This isn’t always the case, some may comfort eat and feed very frequently and not all are sick. Many doctors advise 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 worsen with developmental milestones, teething episodes, viral illness and weaning.

Silent Reflux

Some babies with reflux do not vomit at all. This is actually more of a problem because the acidic stomach contents go up the throat and back down again, causing twice the pain and twice the damage. There is no clear relationship 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 few months of their life, known as spitting up. Most of those children will outgrow their reflux by their first birthday. However, a small but significant number of them will not outgrow the condition. This is particularly true where there is a family history of GERD present.