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Understanding the Differences Between GER and GERD

With so many different terms used for GER, GERD and reflux, it is easy to see why these disorders can be confused. We aim to break down the differences between GER and GERD into terms that make it easier to understand and “digest”.

Gastroesophageal Reflux (GER)

Gastroesophageal reflux (GER) occurs when contents from the stomach travel back up into the esophagus causing unpleasant symptoms in the gastrointestinal (GI) tract.  GER is caused when the muscle called the lower esophageal sphincter (LES), which separates your esophagus and stomach does not tighten or close properly. This allows stomach contents to travel backwards and may cause symptoms such as cough, sore throat, bitter or sour taste, and burning or pressure in the chest or throat.  Other symptoms may include bad breath, nausea/vomiting, problems swallowing, respiratory problems, and tooth decay.  GER may also be commonly referred to as reflux, acid reflux, heartburn, acid regurgitation, and indigestion.  Occasional GER is common in children and teens, ages 2-19 years, and does not mean that they will develop gastroesophageal reflux disease (GERD)1. It is important to note in babies, this presents as spit up and even with frequent spit ups, it can be completely normal. Often, simple changes to eating habits and lifestyle can helps reduce symptoms and frequency.

Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is a more serious, chronic form of GER. Although more common in adults, up to 25% of children and teens have symptoms of GERD1.  GERD can lead to more serious health problems if left untreated, so it is important to be evaluated and treated by a doctor if symptoms are frequent or continue for a prolonged period of time.  If symptoms of GER (reflux) are severe -such as difficulty swallowing – or they do not improve over time with lifestyle changes, then GERD is often considered.

Diagnosis

Diagnosis of GER or GERD usually begins with the physician taking a medical history and understanding the symptoms.  Often, physicians will suggest lifestyle changes to see if symptoms improve. If symptoms do not improve with these lifestyle changes, then testing for GERD may be recommended.  Tests may include one or more of the following: upper GI series, esophageal pH and impedance monitoring, or upper gastrointestinal (GI) endoscopy and biopsy.

Treatment

Treatment options for GER and GERD can vary but typically start with lifestyle changes such as not eating or drinking foods/beverages that cause symptoms, eating smaller meals, avoiding meals 2-3 hours before bedtime, staying upright for 3 hours after meals, and weight loss if the child is overweight or obese.  In infants with GER symptoms, it may be recommended to decrease the size of the feedings, burp frequently, and in some cases, the physician may suggest a trial of a different formula due to concern for protein sensitivity. In cases where symptoms do not improve with lifestyle changes, over the counter or prescription medications may be recommended.  There are a variety of medications that may be effective in relieving symptoms including: antacids, H2 blockers, proton pump inhibitors (PPIs), prokinetics, and in some cases, antibiotics. In cases where lifestyle changes and medications are not effective, surgery may be recommended.  It is best to discuss with a physician which treatment method is right for your child.

Complications of Untreated GERD

While it may be tempting to move forward without treating GERD in your child, it is important to understand that untreated GERD can cause more serious complications over time if left untreated.  Below we discuss some of these possible complications.

Esophagitis

Esophagitis is inflammation or irritation of the esophagus.  This inflammation may cause damage to the tissue of the esophagus and sometimes leads to ulcers, also known as sores.  Esophagitis can be painful and may cause chest pain or difficulty swallowing.

Esophageal Stricture

An esophageal stricture occurs when the esophagus becomes narrowed and may cause problems with swallowing. In young children, strictures may lead to feeding refusal, coughing or gagging.  In severe or prolonged cases, this narrowing of the esophagus can cause foods or medications to feel stuck in the throat and may even lead to a food impaction.  If this occurs, an esophageal dilation may be necessary to open-up the esophagus and allow food to pass more normally. An esophageal dilation is a procedure where a physician uses a small balloon to stretch and open-up the esophagus.

Respiratory Problems or Symptoms

A child with GERD may breathe stomach acid into his or her lungs, causing respiratory problems or symptoms. This is because the stomach acid causes irritation, leading to complications such as increases in asthma symptoms, chest congestion, cough or sore throat, hoarseness, laryngitis, pneumonia and wheezing.  It is important to have a physician manage children with GERD to prevent or minimize any long-term complications.

I’m Still Confused About Heartburn

The term heartburn can be very misleading since it does not have anything to do with the heart, but rather occurs in the digestive system.  This occurs when stomach contents, including the stomach acid, reach the esophagus which is more delicate than the stomach and unable to tolerate the effects of the acid.  Heartburn can be mild to severe and is often described as a burning in the chest or throat.  Some people even experience sharp pains, burning, or a tightening sensation.  Because of these symptoms, it is sometimes mistaken for a heart attack, hence the name “heartburn”.  Essentially, heartburn is a symptom of reflux or GERD.

Reflux, Food Allergies and Eosinophilic Esophagitis (EoE)

Some forms of reflux have been shown to be associated with food allergic disorders including cow’s milk allergy (CMA) and eosinophilic esophagitis (EoE).  In fact, one study found that 1/3 of patients under the age of 2 with symptoms of GERD were diagnosed with CMA2.  Another study found that children with GERD who were treated with medications known as gastric acid suppressive (GAS) medications were more likely to develop food allergies3.  In children with eosinophilic esophagitis (EoE), reflux and difficulty swallowing are common symptoms.  Both GERD and EoE can cause elevated numbers of eosinophils in the esophagus, making it sometimes difficult to differentiate between GERD and EoE.  Due to the overlap in these symptoms and conditions, talking with a physician may help parents to resolve their concerns about reflux and/or food allergies.

Formulas That Support Healthy Digestion

Elemental formulas are not common treatments for GERD, but they are a common formula choice for food allergies or GI disorders that often display symptoms of GERD.  EquaCare Jr. provides an affordable amino acid-based formula option for those over 1 year of age and Essential Care Jr. is an amino acid-based formula for children over 1 year of age with value added ingredients, such as fiber and prebiotics, that may support healthy digestion.  Learn more about each of these beneficial products by visiting us online today or calling 1-833-377-2773.

References:

  1. Nelson SP, Chen EH, Syniar GM, Christoffel KK. Pediatric Practice Research Group. Prevalence of symptoms of gastroesophageal reflux during childhood. Archives of Pediatric and Adolescents Medicine. 2000;154:150–154.
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3166669/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4528619/
  4. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-children-teens
  5. https://gikids.org/gerd/