Bay Area Pediatric Pulmonary Medical Corporation - BAPP - Gastroesophageal Reflux Disease and Your Lungs

A thorough medical history and physical examination by clinicians trained to look for GERD as a "hidden" problem. When GERD is suspected, sometimes a trial of medications can help clarify if GER is really a problem. A clear response to medications or to the way a child / baby is fed can sometimes be as good as any medical test. Sometimes tests are needed and these can include:

Chest "x-ray" to look for abnormal lung shape, lung collapse, pneumonia, etc.

Barium swallow, esophagram, and upper GI series. The patient swallows chalky material and has xrays to show how the material is swallowed; if the lungs are protected during swallowing; and how food moves through the esophagus, stomach, and small intestine. The pictures show the shape of the esophagus, stomach, and small intestine to make sure no kinks or blockages are causing stomach contents to "back-up" into the esophagus. Sometimes GERD can be seen during the swallow study, but even when not GER is seen during the few minutes of the test, GER can still be a problem. GER does not happen every minute of the day!

pH Probe study. A tube with a meter measuring acid is placed through the nose into the esophagus for 12-24 hours to determine if too much acid from the stomach is entering the esophagus. This test evaluates patients over many hours instead of just a few minutes (as with the barium swallow). The test is performed by the GI department.

Endoscopy. A camera is placed into the esophagus and stomach to look for irritation, infection, and ulcers.

Bronchoscopy. A camera is placed into the throat and lung tubes to look for irritation, infection, and abnormalities of the lung tubes.

Pulmonary function testing to measure how well the lungs work.

How to Make GERD Better: Relief Through Lifestyle Changes

Position. Reflux occurs more easily when people lie on their backs because gravity cannot work as well to keep fluid in the stomach. Babies should be kept upright for 30-60 minutes after a feeding so that gravity can help keep fluid in the stomach until the stomach empties. Elevate the baby's head and chest with a foam wedge, or by raising one end of the crib/bed with bricks, blocks, or books; or by having them sleep in a car seat. For infants older than 5-6 months, you can try having them sit in "saucer-seats".

Avoid Pressure on the Abdomen which can push stomach contents up into the esophagus. Keep babies out of the abdominal "crunch" position. Avoid tight diapers. Try not to jostle or hug babies too vigorously right after feedings.

Smaller Feedings. Large meals, like Thanksgiving dinner, puts more pressure on the stomach to empty forwards and backwards. Smaller more frequent feedings can provide good nutrition without making reflux worse. Burping your baby thoroughly during and after meals helps to release pressure caused by air. Thickened feeds can help babies swallow more easily and can help babies keep the heavier & thicker contents down in the stomach. (Try adding 1-2 teaspoons of dry rice cereal to each ounce of formula or breast milk. You will need to widen the hole of the bottle to allow the thicker fluid to flow easily.) Consider changing the formula if your child has allergies to dairy or soy because food allergies can cause vomiting too.

Foods to avoid. Older children should avoid eating before bedtime so that the stomach is not full and churning at a time when gravity cannot help keep stomach contents down. Large, fatty, and acidic (citrus, tomato, carbonated drinks, coffee, caffeine, chocolate, and mint) meals can worsen GERD.

How to Make GERD Better: Relief Through Medications

Acid-blocking medications (Famotidine/Pepcid, Ranitidine/Zantac, Cimetidine/Tagament, Prevacid, Omeprazole/Prilosec) work by reducing stomach acid before it can cause damage. In adults, many of these medications are available over-the-counter, but for children, a prescription is needed. Pro-motility medications (metoclopramide/Reglan, erythromycin, bethanechol) help by moving the stomach contents forward so that stomach contents will be less likely to back up into the esophagus. Your doctor can help you balance the benefits and side effects of your child's medication.

How to Make GERD Better: Surgery

Children with mild reflux usually improve with time and lifestyle changes. Moderate reflux can usually be controlled with lifestyle changes and medications. Surgery is reserved for patients with severe GERD who do not respond to medications or who have moderate-severe complications (like worsening lung problems). For some patients, GERD is so severe that only surgery and medications together can control the problem.

Gastroesophageal Reflux Disease and Your Lungs

Gastroesophageal reflux disease, (GERD) is common problem for adults and pregnant women which is often referred to as "heartburn" or "wet burps". This familiar discomfort occurs when there is too much pressure on the stomach, too much stress, or when lying down. In children and babies, GERD can be an unsuspected problem because children and babies cannot describe their discomfort, and because their stomach problem can show up as breathing problems.

During normal swallowing, food and liquids travel past the entrance of the lungs and into the feeding tube (esophagus) toward the stomach. The entrance of the lungs is the larynx ("voice box") which closes to protect the lungs from irritants and opens to allow us to breath. The junction of the esophagus and the stomach is the "lower esophageal sphincter" which is a muscular ring that loosens to allow food into the stomach and tightens to prevent the exit of food, fluids, and stomach acid from the stomach backward into the esophagus. Later, contents in the stomach move forward out the other end of the stomach into the intestines.

Gastroesophageal reflux occurs when stomach contents (consisting of stomach acid and partially digested food or liquid) come back up into the esophagus. "Gastro" refers to stomach, and "reflux" refers to movement backwards from normal. It can be normal to have some degree of brief and uncomplicated gastroesophageal reflux.

On the other hand, "pathologic GER" or "gastroesophageal reflux disease" (GERD) occurs when the number and length of reflux episodes is abnormal and is causing health problems. GERD is the most common cause of chronic vomiting in infants. GERD can cause irritation to the esophagus resulting in esophagitis or inflammation of the esophagus and can cause discomfort which adults refer to as "heartburn".

GERD and Respiratory Problems

GERD can cause respiratory problems when the stomach contents enter the lungs and cause irritation and inflammation. Aspiration is a term describing when something besides air is getting into the lungs. GERD with aspiration occurs when stomach contents rise upward from the stomach toward the mouth and enters the lungs. This can result in coughing, wheezing, bronchitis, pneumonias, and noisy breathing. Even GERD without aspiration can cause lung problems because the stomach contents splashing into the esophagus irritate the neighboring lungs and cause wheezing, coughing, and breathing difficulties.

Even though GERD is a feeding and digestive problem, it can also cause breathing problems. In people who already have lung problems, GERD and aspiration can make the lung problems worse.

For most infants and children and adults, GER is a mild problem that can resolve without medications or surgery. Most patients do not have breathing problems due to GER. When breathing problems are worsened by GER, the patient's GER is considered to be unusually severe.

Gerd Symptoms in Infants

Irritability, Pain
Torticollis and Abnormal Behavior ("Sandifer's Syndrome")
Poor weight gain because of difficulty breathing or eating
Vomiting, Easy Regurgitation
Coughing and Sputtering with Regurgitation
Noisy Breathing, "Stridor",
Laryngitis, Abnormal Voice, Bad breath.
Unexplained Wheezing or Asthma Attacks
Chronic Cough
Bronchitis, Pneumonia
Respiratory Distress (chest retractions, nose flaring)
"Near Death" Episodes
Bradycardia (decreased heart rate)
Apnea ("pauses" in the breathing pattern)
Discoloration (blue or gray or "dusky" color; cyanosis)

Gerd Symptoms in Older Children and Adults

Esophagitis, "Heartburn",
Chest Pain behind the breastplate ("heartburn, esophagitis)
"Acid back-wash" (Some people actually can taste the bitter stomach acid in their mouths or feel burning in their noses.)
Voice Changes
Bad breath
Coughing spells at night
Unexplained lung problems (like wheezing attacks)
Surprisingly, some people have GERD but do not have any of the usual symptoms.