What is GERD?

GERD (Gastroesophageal reflux disease) is defined as chronic symptoms or damage produced by the the abnormal reflux in the esophagus which is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach. Common causes include the incompetence of the lower esophageal sphincter, transient lower esophageal sphincter relaxation, impaired expulsion of gastric reflux from the esophagus, or a hiatal hernia.

While GERD is commonly found in adults, it may be difficult to detect in infants and children. GERD symptoms may vary in children versus adults. Children may have one symptom or many - no single symptom is universal in all children with GERD.

Signs and Symptoms

• Heartburn
• Regurgitation
• Trouble swallowing (also known as Dysphagia)

• Pain with swallowing
• Excessive salivation
• Nausea
• Chest pain

• Reflux Esophagitis - necrosis of esophageal epithelium causing ulcers near the junction of the stomach and esophagus.
• Esophageal Strictures - persistent narrowing of the esophagus caused by reflux-induced inflammation.
• Barrett's Esophagus - changes of the epithelial cells from squamous to columnar in the distal esophagus.
• Esophageal Adenocarcinoma - a rare form of cancer.

• Chronic Cough
• Laryngitis (hoarseness, throat clearing)
• Asthma
• Erosion of dental enamel
• Dentine hypersensitivity
• Sinusitis and damaged teeth

• 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 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 feedings
• 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 feeding 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 esphageal sphincter becomes more competent so the vomiting should begin to show signs of improvement and eventually stop. Not all babies and children with reflux are underweight. Most children will outgrow their reflux by their first birthday, but a small but significant number of them will not outgrow the condition especially when there is a family history of GERD present.

• Some babies with reflux do not vomit at all. This is actually worse of a problem because the acidic stomach contents go up the throat and back down again, causing twice the pain and twice the damage.

Surgical Treatment

The standard surgical treatment is the Nissen fundoplication. In this procedure, the upper part of the stomach is wrapped around the lower esophageal sphincter (LES) to strengthen the sphincter and prevent acid reflux as well as to repair a hiatal hernia. This procedure is done laparoscopically.