Gastroesophageal Reflux Disease (GERD)
More than 40 percent of normal babies spit-up (also known as regurgitating). This is due to an immature sphincter (a muscle like an elastic band) that is too weak to control exit from a baby's stomach. Because the sphincter is immature and not working well, contents of the stomach are pushed back up into the esophagus or all the way up to the mouth as the stomach contracts to digest the food. When there are no health consequences, this is known as simple spitting-up or Gastroesophageal Reflux (GER). However, when there are associated health consequences, it is referred to as Gastroesophageal Reflux Disease (GERD).
The Two General Categories of GERD
A baby spits up so much that not only is it visible, but, unlike simple GER, it prevents normal weight gain and growth.
Invisible or Not-So-Obvious GERD
The reflux of the stomach contents do not travel all the way up to the mouth. They go up only into the esophagus or to the back of the throat.. This non-regurgitant form of reflux can cause health problems. Esophagitis is an irritation of the esophagus caused by the acid that refluxes back up. The symptoms are like heartburn, and in babies it usually is pain and crying while feeding. Reflux contents in the esophagus and throat area can also cause apnea, cough, and worsen asthma symptoms (even without obvious GERD signs).
Tests for GERD
When we suspect that a baby's regurgitation prevents weight gain, special X-rays can confirm the reflux and its extent. In other situations where there is no obvious vomiting or spitting up, and GERD is suspected, a specific test called a pH Probe can measure the acidity level in the esophagus. Normally, there should be no acid in the esophagus and if there is, it confirms reflux.
There are several treatment approaches for GERD, including the use of prescribed medications that reduce the stomach acid level or help with stomach movement (motility). Very rarely, in severe cases of visible regurgitation causing significant growth delay or failure to gain weight, surgical repair may be required. The specific type of treatment approach depends on the individual situation.