Acid Reflux
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GASTRO-ESOPHAGEAL OR ACID REFLUX This condition, in which material in the stomach, especially acid, refluxes or regurgitates into the esophagus [the tube between the back of the mouth and stomach], can occur at any age.
It isn’t clear if the mechanism of reflux is the same at all ages, but treatment implications and the effects of the disorder are different. Long-standing uncontrolled acid reflux may have very serious consequences as noted below.
THE BASIS OR MECHANISM OF ACID REFLUX
Acid reflux results from failure of the closing mechanism between esophagus and stomach and delayed emptying of the stomach.
SYMPTOMS AND SIGNS
Acid reflux, asthma, allergic nose or rhinitis and the skin condition atopic dermatitis (eczema) are related disorders in that an individual patient may have two or more of these disorders at the same time or during different times in their lives. The simultaneous occurrence of these in the same patient is more than coincidental and one or more of the disorders may be present in other family members.
LEVELS OF SEVERITY & DIAGNOSIS
A diagnosis of acid reflux is generally made without laboratory testing and/or x-rays. In the unusual case endoscopic examination [passing a tube down the esophagus] and biopsy of the esophagus by a specialist are necessary.
The level of severity of acid reflux dictates the way acid reflux is treated.
Severe long-standing acid reflux can rarely lead to abnormalities in the lining of the esophagus that predispose to cancer of the esophagus. This is called Barrett’s change and is diagnosed by biopsy. The chances of your child suffering this problem are very small. If you are worried ask about it.
Aside from relief of symptoms treatment of acid reflux is directed at preventing this serious complication and in some instances removing the source of aspiration and related respiratory symptoms.
THINGS THAT INCITE OR AGGRAVATE ACID REFLUX
The recognition of things that incite acid reflux is an important aspect of management since the avoidance or control of these may prevent or minimize occurrences. Parents and patients should be alert to those events, foods, etc. that precede acid reflux and inform caretakers of them. Some examples of incitants are: spicy foods, carbonated drinks, caffeine-containing drink/food, chocolate, clothing that is tight around the waist or abdomen, reclining soon after eating or drinking,
TREATMENT Some general life-style changes include:
These remedies should be used for an indefinite period whereas medications vary in the duration of treatment. MEDICATIONS Antacids or drugs that inhibitor acid production by the stomach are the cornerstones of treatment. It is the acid in refluxed material that is most harmful. If the production of acid in the stomach can be neutralized or minimized the effects of reflux will be reduced. These agents should be used before going to bed at night and at other times during the day if necessary. Discuss the proper use of these medications with your child’s doctor.
There are many over-the-counter antacids that one might try. Pepcid AC is one of these that reduces acid production. Others neutralize the acid that is produced. Some forms of Pepcid contain both types of drugs.
Prescription medications are available. The options should be discussed with your child’s doctor.
GE reflux in young infants is generally associated with excessive spitting/vomiting and requires no treatment unless the baby is failing to grow as expected or has respiratory problems.
In patients with acid reflux and asthma the latter may be difficult to control as long as the acid reflux remains uncontrolled.
Nov. 2001 ©2002 South Valley Pediatrics
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