Gastroesophageal Reflux Disease—Adolescent
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Gastroesophageal Reflux Disease—Adolescent

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

Pronounced: Gas-tro-ee-sof-a-geal re-flux

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.

GERD can occur at any age and typically requires lifestyle changes, medications, and sometimes surgery. This condition can cause serious health issues. The sooner it is treated, the better the outcome.

Gastroesophageal Reflux Disease

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© 2008 Nucleus Medical Art, Inc.

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 heartburn, 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
  • Possibly a genetic link

Other causes include diseases that interfere with food passing through the esophagus or cause excess acid production.

Risk Factors

Unlike infants and children, there are not many known risk factors for the development of GERD among adolescents. Obesity , a risk factor for adults, may also increase the risk of developing this condition among teenagers. Smoking and using alcohol may also put teens at risk.

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. If your child has any of these, tell the doctor:

  • Heartburn
  • Abdominal or chest pain
  • Regurgitation
  • Vomiting
  • Need to clear throat
  • Bloody vomit
  • Bad breath
  • Difficulty swallowing
  • Worsening asthma
  • Recurrent pneumonia or respiratory problems
  • Sore throat
  • Cough, wheezing, or hoarseness
  • Dental problems (due to the effect of the stomach acid on the tooth's enamel)

Diagnosis

Your doctor will ask about your teen’s symptoms and medical history, and perform a physical exam. Your child may need to see a gastroenterologist, a doctor who specializes in gastrointestinal diseases.

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 medicine

Treatment

Talk with your doctor about the best treatment plan for you. 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 on the left side
  • Avoiding certain foods, such as:
    • Chocolate
    • Fried foods
    • Peppermint
    • Spicy foods
    • Caffeine products
    • Carbonated beverages
    • Foods high in fat and acid

If your teen is obese, your doctor may recommend weight loss. Also, talk to your teen about smoking and alcohol, which can worsen GERD symptoms.

Medications

Medications may include:

  • Histamine-2 receptor drugs—to decrease acid production (eg, Tagamet, Pepcid, Zantac)
  • Proton pump inhibitors—to heal the esophagus lining and relieve symptoms (eg, Prilosec, Prevacid, Protonix, Nexium)
  • Promotility drugs—to help slow stomach emptying (eg, Reglan)
  • Over-the-counter antacids—to treat heartburn relief (eg, Tums, Maalox)
Many of these are over-the-counter medications. Talk to your teen's doctor about any new medication.

Surgery

In severe cases, the doctor may recommend surgery. The most common treatment 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.

Prevention

While some of the causes of GERD in adolescents are unknown, your teen can take these steps to control the condition:

  • Following the doctor's dietary and lifestyle changes
  • Avoiding smoking and second-hand smoke
  • Avoiding drinking alcohol
  • Keeping a diary of symptoms

RESOURCES:

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

National Digestive Diseases Information Clearinghouse (NDDIC)
http://digestive.niddk.nih.gov/index.htm

CANADIAN RESOURCES:

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

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

References

Dente K. Quick lesson about gastroesophageal reflux disease in children and adolescents. EBSCO Nursing Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16topicID=860 . Accessed May 19, 2008.

Gastroesophageal reflux disease (GERD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Accessed May 19, 2008.

Gastroesophageal reflux in children and adolescents. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gerinchildren/index.htm . Accessed May 19, 2008.

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.

GERD in children with an underlying structural anomaly. Children’s Digestive Health and Nutrition Foundation website. Available at: http://gerd.cdhnf.org/User/Docs/PDF/CUSA_Brochure.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_8_pg_brochure_031604.pdf . Accessed May 19, 2008.

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



Last reviewed May 2008 by Kari Kassir, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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