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Gastroesophageal Reflux (GER)

What is gastroesophageal reflux (GER)?

Gastroesophageal reflux (GER) is a digestive disorder that is caused by gastric acid flowing from the stomach into the esophagus.

Gastroesophageal refers to the stomach and esophagus, and reflux means to flow back or return. Gastroesophageal reflux is the return of acidic stomach juices, or food and fluids, back up into the esophagus.

Gastroesophageal reflux is common in babies, although it can occur at any age. It is the most common cause of vomiting during infancy. It may be a temporary condition, or may be a long-term physical problem, often called gastroesophageal reflux disease (GERD).

Illustration demonstrating gastroesophageal reflux

What causes gastroesophageal reflux (GER)?

Gastroesophageal reflux is often the result of conditions that affect the lower esophageal sphincter (LES). The LES, a muscle located at the bottom of the esophagus, opens to let food in and closes to keep food in the stomach. When this muscle relaxes too often or for too long, acid refluxes back into the esophagus, causing vomiting or heartburn.

As feedings are digested, the LES opens and allows the stomach contents to go back up the esophagus. Sometimes, the stomach contents go all the way up the esophagus and the baby vomits. Other times, the stomach contents only go part of the way up the esophagus, causing heartburn, breathing problems, or, possibly, no problems at all.

Why is gastroesophageal reflux (GER) a concern?

Some babies who have GER may not vomit, but may still have stomach contents move up the esophagus and spill over into the windpipe. This can cause asthma, pneumonia, and possibly even SIDS (sudden infant death syndrome).

Babies with GER who vomit frequently may not gain weight and grow normally. Inflammation (esophagitis) or ulcers (sores) can form in the esophagus due to contact with stomach acid. These can be painful and also may bleed, leading to anemia (too few red blood cells in the bloodstream). Esophageal narrowing (stricture) and Barrett's esophagus (abnormal cells in the esophageal lining) are long term complications from inflammation.

What are the symptoms of gastroesophageal reflux (GER)?

The following are other common symptoms of GER. However, each baby may experience symptoms differently. Symptoms may include:

The symptoms of GER may resemble other conditions or medical problems. Always consult your baby's physician for a diagnosis.

How is gastroesophageal reflux (GER) diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures that may be performed to help evaluate gastroesophageal reflux include:

Treatment for gastroesophageal reflux (GER):

Specific treatment for gastroesophageal reflux will be determined by your baby's physician based on:

In many cases, GER can be relieved through feeding changes, under the direction of your baby's physician. Some ways to better manage GER symptoms include the following:

Treatment may include:

Many babies with GER will "outgrow it" by the time they are about a year old, as the lower esophageal sphincter becomes stronger. For others, medications, lifestyle, and diet changes can minimize reflux, vomiting, and heartburn. Surgery may be required in severe cases.

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