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Paediatric Gastro-oesophageal Reflux Disease

OVERVIEW

Gastroesophageal reflux disease, commonly labelled GERD, is a digestive condition that happens when the stomach contents flow back into the oesophagus. It is a more persistent and severe form of gastroesophageal reflux.

GERD is prevalent among infants below 2 years of age, and it is normal for them to spit up a few times daily in the first three months of life. However, this does not cause any problems in infants, and they usually outgrow it by the time they are between 12 and 14 months old.

Children and teenagers between the ages of 2 and 19 also experience gastroesophageal reflux from time to time, but this does not necessarily indicate that they have GERD.

Signs and symptoms of gastro-oesophageal reflux

GERD is typically characterised by heartburn or acid indigestion, which is a burning sensation in the chest. This sensation begins behind the breastbone and can extend to the neck and throat, lasting up to two hours. It is often exacerbated after eating or lying down, or bending over following a meal.

However, children below the age of 12 typically present with different symptoms of GERD, such as a dry cough, asthma symptoms, or difficulty swallowing. They may also experience classic heartburn.

GERD symptoms can vary among children, with common indicators including:

Burping or belching
Stomach pain
Fussiness around mealtimes
Frequent vomiting
Hiccups
Gagging
Choking
Frequent coughing or coughing fits, especially at night

Other symptoms may include:

Wheezing
Frequent colds or ear infections
Rattling in the chest
Morning sore throat
Sour taste in the mouth
Bad breath
Loss or decay of tooth enamel.

These symptoms may be similar to other health issues, so it is crucial to consult a healthcare provider for an accurate diagnosis.

Treatment

Not all children with reflux require medication or surgery. In some instances, modifying their diet and lifestyle may be sufficient. However, your child may require medication and/or surgery to address their reflux. Each case is treated on an individual basis, utilising all available options to attain the safest and most favourable outcome for both your child and your family.

If your child is experiencing severe reflux, the paediatric surgeon may recommend a surgical procedure called fundoplication. This may be necessary if your child is vomiting frequently and not gaining weight, experiencing frequent breathing difficulties, or has severe oesophageal irritation. Typically, this procedure is performed using laparoscopic surgery, which entails minimal pain and a quicker recovery time. Small incisions or cuts are made in the child's abdomen. A small tube with a camera attached is placed into one of the incisions to visualise the internal organs. The surgical tools are inserted through the other incisions. The surgeon monitors a video screen to view the stomach and surrounding organs. The upper portion of the stomach is wrapped around the oesophagus to create a tight band, thereby strengthening the LES and significantly reducing reflux.

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Dr Mangray, the founder of KZN Specialised Paediatric Surgical Service, and his associates, Dr Ngobese, Dr Govender and Dr Dube-Zvirikuzhe, have a well-established reputation for caring for children right until late adolescence.

FREQUENTLY ASKED QUESTIONS

FAQ

1Is GERD the same as acid reflux?

GERD is a more severe and chronic form of acid reflux. While acid reflux is a common digestive problem, GERD is a long-term condition that can lead to complications if left untreated.

2Can certain foods trigger GERD symptoms?

Yes, certain foods can trigger GERD symptoms, such as spicy or fatty foods, chocolate, caffeine, alcohol, and citrus fruits. It's important to keep a food diary and identify which foods may be causing symptoms, and then avoid or limit them as much as possible.

3Is GERD in children serious?

While GERD can be uncomfortable and cause symptoms, it is typically not a serious condition. If left untreated, GERD can cause complications such as inflammation of the oesophagus or breathing difficulties. Seeking medical advice is crucial if you suspect that your child is suffering from GERD.