Pediatric Reflux and Esophageal Disorders
As a parent, it is difficult to see your child in pain as they deal with the uncomfortable effects of reflux disorders, such as gastroesophageal reflux disease. Our pediatric gastroenterology specialists are dedicated to searching for answers for why your child is suffering from these uncomfortable symptoms. Though there are a variety of conditions that cause chronic reflux, our specialists are equipped with the skills to determine the best course of treatment for your child.
What are reflux and esophageal disorders in children?
The esophagus is the muscular tube that connects the mouth to the stomach. Its role is to squeeze food and liquid that has been swallowed down into the stomach where the digestive process starts. Esophageal reflux is the passage of these food contents and the acid produced normally in the stomach back into the esophagus. Esophageal reflux can be normal in any age especially after a meal and is often asymptomatic. In infants this is especially true, and reflux can be normal. This is because a infant’s esophagus is smaller and the muscles of the esophagus are still maturing. In infants this reflux often regurgitates to and out of the mouth or can be even seen as vomiting.
However, esophageal reflux that causes a problem is different and this is referred to as GERD. GERD (Gastroesophageal reflux disease) is a esophageal disorder that can occur at any age including infants. GERD happens when reflux including food and acid passes into the esophagus and causes problems including pain (heartburn, chest pain, sore throat), swallowing or eating problems, airway symptoms like cough, and over time scarring of the esophagus or rarely in children, precancerous changes.
Another esophageal disorder seen in children is eosinophilic esophagitis. This condition occurs when a topical allergen (usually a food) causes a allergic reaction in the lining of the esophagus. The resulting inflammation over time results in a dysfunctional esophagus that cannot squeeze correctly or develops scars. Symptoms usually are swallowing problems, chest pain, abdominal pain and reflux symptoms that do not improve with GERD therapy. Swallowing problems with food getting stuck during eating is the most common symptom seen in children and adolescents.
What are symptoms associated with GERD and Eosinophilic Esophagitis (EoE)
- Blood in vomit
- Swallowing problems
- Food stuck in esophagus
- Abdominal pain
- Feeding and eating problems
- Sleep disturbance
How are esophageal disorder diagnosed?
- Evaluation by a Pediatric Gastroenterologist
- Trial of acid medicine
- Radiology tests
- Upper endoscopy
- Esophageal pH/impedance study
How are esophageal disorders GERD and EoE treated?
In infants, esophageal reflux that is normal can usually be monitored especially if the infant is growing eating and developing normally. In both infants and older children, diet changes and avoidance of foods is typically 1st line treatment. In infants diet change for suspected GERD most commonly is avoidance of Cow’s milk protein found in formula or breastfeeding mother’s diet. In older children, specific diet recommendations and sleeping patterns or “lifestyle” treatment should be tried such as avoiding spicy, greasy, tomato, etc and not eating before sleep and propping up at night. However, when needed and indicated, medical therapy with acid suppressive medications have been shown in children and infants to work well. A pediatric GI can guide the patient and family on right treatment choice.
In EoE, treatment is focused on reducing inflammation with either medication or dietary elimination or a combination of both. Medications used to treat EoE include high dose acid medication and topical swallowed steroids. Diet elimination focuses on identifying food or foods through allergy testing, or when allergy testing does not help, then elimination trials of up to 6 of the most common allergic foods. Again, a pediatric gastroenterologist with help guide the patient and family to the right treatment.
Our specialists are dedicated to finding the best treatment options and to work with you to help improve the esophageal disorder affecting your child’s life.
Our specialists also work collaboratively with our colleagues at Golisano Children’s Hospital of Southwest Florida including nutritional specialists, and radiologists in the diagnostic and treatment process.