Digestive and Gastrointestinal Conditions

Gastroesophageal Reflux

What is gastroesophageal reflux?

Gastroesophageal reflux disease (GERD) (pronounced gas-troh-eh-sof-uh-jee-uhl re-flux) occurs when food and stomach acid back up (reflux) into the tube that goes from the mouth to the stomach (esophagus).

Normally, a complex mechanism made up of 3 parts prevents reflux. These parts are:

  1. The muscle around the esophagus as it enters the belly (abdomen)
  2. The part of the esophagus that’s in the abdomen before it enters the stomach
  3. The angle at which the esophagus enters the stomach

In simple terms, some people describe these elements as a valve between the stomach and esophagus, but no specific valve really exists.

Stomach acid can hurt the esophagus and cause a burning feeling or pain. This may make your baby fussy or unwilling to eat much. Reflux can also lead to other problems, such as pneumonia, breathing problems and difficulty gaining weight.

Gastroesophageal reflux is common in babies. About half of them have it. Most outgrow it by the time they are 6 months to 1 year old.

Gastroesophageal Reflux at Seattle Children’s

We treat many children with gastroesophageal reflux. Most of these children do not need surgery. In many cases, we work closely with doctors who are experts in the digestive system (gastroenterology) or lungs (pulmonary) to help make the decision about whether an operation will benefit your child.

  • Before we recommend surgery, we do a thorough check of your child’s health. We talk with you to determine whether steps other than surgery may help your child. An important part of our service is our work with children and families to get good results without surgery whenever possible.

    Because we believe that many children can be well taken care of without surgery, we tend to do fewer of these operations than other children’s health centers. If your child does need surgery, however, our doctors are very experienced.

  • Our surgeons have performed hundreds of the operations children need to correct reflux. They usually do 50 to 75 of these operations each year. Our surgeons can recommend whether a laparoscopic surgery, or minimally invasive, operation is best for your child or whether an open operation with a larger incision may be a better choice. Most of the time our surgeons correct gastroesophageal reflux with laparoscopic surgery.

  • When you come to Seattle Children’s, you have a team of people to care for your child before, during and after surgery. Along with your child’s surgeon, you are connected with nurses, dietitians, child life specialists and others. We work together to meet all of your child’s health needs and help your family through this experience.

    We work with children and families from around the Northwest and beyond. Whether you live nearby or far away, we can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Learn about our services for patients and families.

  • Through Seattle Children’s growing research program, we are discovering better ways to care for children before, during and after surgery. We are committed to bringing the new knowledge we gain from research to the bedside – so that our region’s children receive the treatments and procedures that have the very best outcomes.

    Among other symptoms, children with GERD spit up frequently, which leads to poor nutrition, lack of normal development and aspiration pneumonia – the result of inhaling food particles into the lungs. Some spitting up is normal, and GERD-like symptoms can be caused by other conditions. The result can be a lot of uncertainty about how to diagnose and treat the disease.

    Seattle Children’s surgeon Dr. Adam Goldin developed a unique algorithm to diagnose GERD and determine if surgery is the best option. In the United States, anti-reflux surgical procedures are the third most frequently performed operation in children. Patients who come to Seattle Children’s are now evaluated using Goldin’s model, and he is tracking their outcomes to analyze how well the system works. His most recent published study found that surgery was associated with an overall decrease in the rate of hospitalizations for reflux-related issues for children 3 years old and younger. Dr. Goldin is currently working on several studies that will further define reflux and its impact in order to identify which children are truly most likely to benefit from surgical procedures.

Symptoms of Gastroesophageal Reflux

Your baby may have 1 or more of these symptoms of gastroesophageal reflux: 

  • Frequent spitting up or vomiting
  • Coughing, choking, gulping swallows or trouble breathing if spit-up is in their throat
  • Fussiness or crying throughout the day, especially 1 to 2 hours after feeding
  • Restless sleep or waking often due to discomfort
  • Changes in breathing patterns or long pauses in breathing (apnea)
  • In older children, problems such as asthma (PDF) or chronic sinus trouble (PDF) can be linked to gastroesophageal reflux 

Symptoms tend to be worse when your baby is lying flat and tend to improve when the baby is sitting or held upright.

Gastroesophageal reflux can cause other health problems that have their own symptoms: 

  • Babies who vomit often may not gain weight, or may even lose weight.
  • If spit-up gets into your baby’s windpipe (trachea), it may go into the lungs. This is called aspirating. It can lead to pneumonia, bronchitis or wheezing.
  • If the esophagus is irritated over and over by acid, a scar may develop. This can cause narrowing in the esophagus (stricture) and make it hard to swallow.

Diagnosing Gastroesophageal Reflux

To diagnose gastroesophageal reflux, doctors start by asking questions about your child’s symptoms and feeding patterns. Sometimes the answers are enough to diagnose reflux.

  • If the doctor needs more information, your baby may have a series of X-rays called an upper GI (PDF) (gastrointestinal) series. First your baby will swallow a liquid that shows up on the X-ray. This liquid helps show how well food travels to and stays in the stomach. Doctors order an upper GI series mainly to look for structural, or anatomic, problems that might be causing reflux.

    A common test for babies who might have reflux is a pH probe study. A thin tube with a sensor is passed through your baby’s nose into the esophagus. The probe measures the level of acid there. This test usually lasts 24 hours and is done in the hospital. Babies must stop taking antacid medications for a minimum of 24 hours before the test.

Treating Gastroesophageal Reflux

Most children with gastroesophageal reflux disease improve with simple changes in their feeding and in the way they sit. They may also take an antacid medication. Before thinking about surgery, your child’s healthcare team may suggest taking these steps: 

  • Keep your baby in a straighter, more upright position at all times. Gravity can help keep the food in the stomach.
  • Make your baby’s milk or formula thicker; for example, by adding rice cereal.
  • Feed your baby smaller amounts more often, and burp your baby often during feeding.
  • Give your baby medicines that help food move from the stomach to the intestines faster or that cut down on stomach acid.

Surgery for Gastroesophageal Reflux

If these steps don’t improve your baby’s symptoms, doctors may suggest surgery to create a valve at the bottom of the esophagus. This surgery is called fundoplication (pronounced fun-doe-plik-A-shun). There are several methods for fundoplication. Your child’s doctor will discuss these with you.

In general, during fundoplication the surgeon pulls the top of the stomach up and wraps it around the lower esophagus. Then the surgeon sews the newly formed valve in place and closes the incision. The surgery takes about 1 to 2 hours, and your child will be in the recovery room for another hour.

  • Most often, our surgeons choose to perform a laparoscopic, or minimally invasive, surgery. During minimally invasive surgery, the surgeon makes several small cuts (incisions). Then the surgeon inserts a thin, lighted tube with a camera and their surgical instruments through the incisions. The advantage of laparoscopic surgery is that surgeons don’t have to cut through the stomach muscles. Children may recover faster.

  • Sometimes surgeons need to make 1 longer cut (incision) instead of the smaller incisions for laparoscopic surgery. This is called open surgery. Sometimes this operation is combined with placement of a gastrostomy tube, a feeding tube in the stomach that is placed through the abdominal wall. Your child’s surgeon will discuss this with you if it appears to be the best choice for your child.

  • For some children, another surgical option is to put in a feeding tube called a gastrojejunostomy tube. This tube bypasses the stomach and takes food directly into your child’s small intestine.

  • After surgery, we will give your child pain medicine to make them comfortable. They will get fluids and medicine through an intravenous (IV) line, a tube that goes into a vein. Your child may also need a tube that goes from the nose to the stomach. This is called a nasogastric tube, or NG tube. It helps keep the stomach empty during recovery.

    You can expect your child to stay in the hospital for about 2 to 5 days. At home, you’ll need to keep the incision clean and dry until it heals. The surgery team will teach you how to care for the incision, explain what kinds of food or medicine to give your child and tell you if you need to limit your child’s activity for a while.

    About 2 to 3 weeks after surgery, your child will need to see the surgeon for a follow-up visit. The surgeon will make sure the incision is healing and your child is recovering well.

Contact Us

Contact our Pediatric General and Thoracic Surgery Department at 206-987-2794 for an appointment, second opinion or more information about pectus carinatum.

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