Many pediatricians will confess that ALL infants have "reflux". They feel it's a matter of degree. The conventional wisdom is not to treat unless there is a problem...the pediatrician gets to define what constitutes a problem. Almost all consider gastroesophageal reflux (GER) as pretty innocent. The "D", signifying disease i.e. GERD, is left out because many pediatricians/family doctors do not automatically think of reflux as a disease. It is so common it seems automatically dismissed. The unfortunate result is many children plagued by this disorder thus go without treatment. Clinically it is almost certain infants and children have different symptoms than adolescent and adult patients. It has been demonstrated and confirmed that over 80% of children that need ear drainage tubes have "stomach juice" in the middle ear. This is the absolute truth (Dr. A. Tasker in 2002, findings confirmed by Dr. J. Lieu in 2004). The concept of "escaped" stomach acid causing problems remote to the digestive tract is yet to be widely received. In this case GERD is responsible for the infamous otitis media, ear infection or "fluid behind the ear drum". There is a huge debate about which antibiotic is best because all treatments to eradicate infection seem mediocre in long-term outcomes. It is perfectly clear to me that the infection is often a secondary event, actually a complication of the primary problem which is gastric fluid trapped in the middle ear. How did it get there? Stomach contents travelled past an incompetent check valve at the foot of the esophagus all the way to the oral cavity and right on up the eustachian tube where it lingers as a dangerous foreign invader. Thus trapped fluid stagnates and bacteria grow causing a bad situation to get worse as infection dominates the clinical picture. If the child does not manifest some severe, unusual digestive complaint the source of the problem (GERD) seems rarely, ALMOST NEVER, considered by the care givers, pediatrician or ear/nose/throat surgeon. Infants and children may spit-up, be "fussy eaters", throw up or complain of stomach pain yet never be considered for GERD testing or be a candidate for a therapeutic challenge with GERD medication (not sick enough?). Many other times no one has a clue that they suffer the consquences of GERD because it is infrequent for the child suffering acid reflux to manifest purely digestive complaints. More likely they will have trouble sleeping, snore, cough, wheeze, have sore throats (commonly in the morning), sinus problems, bad breath, constipation, "allergies" that are refractory to conventional therapy, difficulty in school, headaches and more. All caused by the body working fiercely to protect aginst the chemical spill of their home-grown hydrochloric acid. My clinical perception leads me to question the possibility of GERD in any child (or adult!) who has been "negative" when evaluated/tested in a conventional manner for a wide variety of problems.
A just completed study reveals that the tissue from infants/children esophagus remains abnormal long after the symptoms seem to have been "out grown".
A just completed study reveals that the tissue from infants/children esophagus remains abnormal long after the symptoms seem to have been "out grown".