reflux

Your esophagus is the tube that carries food from your mouth to your stomach. Gastroesophageal reflux disease (GERD) happens when a muscle at the end of your esophagus does not close properly. This allows stomach contents to leak back, or reflux, into the esophagus and irritate it.

You may feel a burning in the chest or throat called heartburn. Sometimes, you can taste stomach fluid in the back of the mouth. If you have these symptoms more than twice a week, you may have GERD. You can also have GERD without having heartburn. Your symptoms could include a dry cough, asthma symptoms, or trouble swallowing.

Anyone, including infants and children, can have GERD. If not treated, it can lead to more serious health problems. In some cases, you might need medicines or surgery. However, many people can improve their symptoms by:

• Avoiding alcohol and spicy, fatty or acidic foods that trigger heartburn
• Eating smaller meals
• Not eating close to bedtime
• Losing weight if needed
• Wearing loose-fitting clothes

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

The esophagus is the tube that carries food from your mouth to your stomach. If your baby has reflux, his or her stomach contents come back up into the esophagus. Another name for reflux is gastroesophageal reflux (GER).

GERD stands for gastroesophageal reflux disease. It is a more serious and long-lasting type of reflux. Babies may have GERD if their symptoms prevent them from feeding or if the reflux lasts more than 12 to 14 months.

There is a muscle (the lower esophageal sphincter) that acts as a valve between the esophagus and stomach. When your baby swallows, this muscle relaxes to let food pass from the esophagus to the stomach. This muscle normally stays closed, so the stomach contents don't flow back into the esophagus.

In babies who have reflux, the lower esophageal sphincter muscle is not fully developed and lets the stomach contents back up the esophagus. This causes your baby to spit up (regurgitate). Once his or her sphincter muscle fully develops, your baby should no longer spit up.

In babies who have GERD, the sphincter muscle becomes weak or relaxes when it shouldn't.

Reflux is very common in babies. About half all babies spit up many times a day in the first 3 months of their lives. They usually stop spitting up between the ages of 12 and 14 months.

GERD is also common in younger infants. Many 4-month-olds have it. But by their first birthday, only 10% of babies still have GERD.

In babies, the main symptom of reflux and GERD is spitting up. GERD may also cause symptoms such as:

• Arching of the back, often during or right after eating
• Colic - crying that lasts for more than 3 hours a day with no medical cause
• Coughing
• Gagging or trouble swallowing
• Irritability, especially after eating
• Poor eating or refusing to eat
• Poor weight gain, or weight loss
• Wheezing or trouble breathing
• Forceful or frequent vomiting

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

In most cases, a doctor diagnoses reflux by reviewing your baby's symptoms and medical history. If the symptoms do not get better with feeding changes and anti-reflux medicines, your baby may need testing.

Several tests can help a doctor diagnose GERD. Sometimes doctors order more than one test to get a diagnosis. Common tests include:

• Upper GI series, which looks at the shape of your baby's upper GI (gastrointestinal) tract. Your baby will drink or eat a contrast liquid called barium. The barium is mixed in with a bottle or other food. The health care professional will take several x-rays of your baby to track the barium as it goes through the esophagus and stomach.
• Esophageal pH and impedance monitoring, which measures the amount of acid or liquid in your baby's esophagus. A doctor or nurse places a thin flexible tube through your baby's nose into the stomach. The end of the tube in the esophagus measures when and how much acid comes up into the esophagus. The other end of the tube attaches to a monitor that records the measurements. Your baby will wear this for 24 hours, most likely in the hospital.
• Upper gastrointestinal (GI) endoscopy and biopsy, which uses an endoscope, a long, flexible tube with a light and camera at the end of it. The doctor runs the endoscope down your baby's esophagus, stomach, and first part of the small intestine. While looking at the pictures from the endoscope, the doctor may also take tissue samples (biopsy).

Feeding changes may help your baby's reflux and GERD:

• Add rice cereal to your baby's bottle of formula or breastmilk. Check with the doctor about how much to add. If the mixture is too thick, you can change the nipple size or cut a little "x" in the nipple to make the opening larger.
• Burp your baby after every 1 to 2 ounces of formula. If you breastfeed, burp your baby after nursing from each breast.
• Avoid overfeeding; give your baby the amount of formula or breast milk recommended.
• Hold your baby upright for 30 minutes after feedings.
• If you use formula and your doctor thinks that your baby may be sensitive to milk protein, your doctor may suggest switching to a different type of formula. Do not change formulas without talking to the doctor.

If feeding changes do not help enough, the doctor may recommend medicines to treat GERD. The medicines work by lowering the amount of acid in your baby's stomach. The doctor will only suggest medicine if your baby still has regular GERD symptoms and:

• You already tried some feeding changes
• Your baby has problems sleeping or feeding
• Your baby does not grow properly

The doctor will often prescribe a medicine on a trial basis and will explain any possible complications. You shouldn't give your baby any medicines unless the doctor tells you to.

Medicines for GERD in babies include:

• H2 blockers, which decrease acid production
• Proton pump inhibitors (PPIs), which lower the amount of acid the stomach makes

If these don't help and your baby still has severe symptoms, then surgery might be an option. Pediatric gastroenterologists only use surgery to treat GERD in babies in rare cases. They may suggest surgery when babies have severe breathing problems or have a physical problem that causes GERD symptoms.

The esophagus is the tube that carries food from your mouth to your stomach. If your child has reflux, his or her stomach contents come back up into the esophagus. Another name for reflux is gastroesophageal reflux (GER).

GERD stands for gastroesophageal reflux disease. It is a more serious and long-lasting type of reflux. If your child has reflux more than twice a week for a few weeks, it could be GERD.

There is a muscle (the lower esophageal sphincter) that acts as a valve between the esophagus and stomach. When your child swallows, this muscle relaxes to let food pass from the esophagus to the stomach. This muscle normally stays closed, so the stomach contents don't flow back into the esophagus.

In children who have reflux and GERD, this muscle becomes weak or relaxes when it shouldn't, and the stomach contents flow back into the esophagus. This can happen because of:

• A hiatal hernia, a condition in which the upper part of your stomach pushes upward into your chest through an opening in your diaphragm
• Increased pressure on the abdomen from being overweight or having obesity
• Medicines, such as certain asthma medicines, antihistamines (which treat allergies), pain relievers, sedatives (which help put people to sleep), and antidepressants
• Smoking or exposure to secondhand smoke
• A previous surgery on the esophagus or upper abdomen
• A severe developmental delay
• Certain neurological conditions, such as cerebral palsy

Many children have occasional reflux. GERD is not as common; up to 25% of children have symptoms of GERD.

Your child might not even notice reflux. But some children taste food or stomach acid at the back of the mouth.

In children, GERD can cause:

• Heartburn, a painful, burning feeling in the middle of the chest. It is more common in older children (12 years and up).
• Bad breath
• Nausea and vomiting
• Problems swallowing or painful swallowing
• Breathing problems
• The wearing away of teeth

In most cases, a doctor diagnoses reflux by reviewing your child's symptoms and medical history. If the symptoms do not get better with lifestyle changes and anti-reflux medicines, your child may need testing to check for GERD or other problems.

Several tests can help a doctor diagnose GERD. Sometimes doctors order more than one test to get a diagnosis. Commonly-used tests include:

• Upper GI series, which looks at the shape of your child's upper GI (gastrointestinal) tract. You child will drink a contrast liquid called barium. For young children, the barium is mixed in with a bottle or other food. The health care professional will take several x-rays of your child to track the barium as it goes through the esophagus and stomach.
• Esophageal pH and impedance monitoring, which measures the amount of acid or liquid in your child's esophagus. A doctor or nurse places a thin flexible tube through your child's nose into the stomach. The end of the tube in the esophagus measures when and how much acid comes back up into the esophagus. The other end of the tube attaches to a monitor that records the measurements. Your child will wear the tube for 24 hours. He or she may need to stay in the hospital during the test.
• Upper gastrointestinal (GI) endoscopy and biopsy, which uses an endoscope, a long, flexible tube with a light and camera at the end of it. The doctor runs the endoscope down your child's esophagus, stomach, and first part of the small intestine. While looking at the pictures from the endoscope, the doctor may also take tissue samples (biopsy).

Sometimes reflux and GERD in children can be treated with lifestyle changes:

• Losing weight, if needed
• Eating smaller meals
• Avoiding high-fat foods
• Wearing loose-fitting clothing around the abdomen
• Staying upright for 3 hours after meals and not reclining and slouching when sitting
• Sleeping at a slight angle. Raise the head of your child's bed 6 to 8 inches by safely putting blocks under the bedposts.

If changes at home do not help enough, the doctor may recommend medicines to treat GERD. The medicines work by lowering the amount of acid in your child's stomach.

Some medicines for GERD in children are over-the-counter, and some are prescription medicines. They include:

• Over-the-counter antacids
• H2 blockers, which decrease acid production
• Proton pump inhibitors (PPIs), which lower the amount of acid the stomach makes
• Prokinetics, which help the stomach empty faster

If these don't help and your child still has severe symptoms, then surgery might be an option. A pediatric gastroenterologist, a doctor who treats children who have digestive diseases, would do the surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Heartburn is a painful burning feeling in your chest or throat. It happens when stomach acid backs up into your esophagus, the tube that carries food from your mouth to your stomach.

If you have heartburn more than twice a week, you may have GERD. But you can have GERD without having heartburn.

Pregnancy, certain foods, alcohol, and some medications can bring on heartburn. Treating heartburn is important because over time reflux can damage the esophagus.

Over-the-counter medicines may help. If the heartburn continues, you may need prescription medicines or surgery.

If you have other symptoms such as crushing chest pain, it could be a heart attack. Get help immediately.

Eosinophilic esophagitis (EoE) is a chronic disease of the esophagus. Your esophagus is the muscular tube that carries food and liquids from your mouth to the stomach. If you have EoE, white blood cells called eosinophils build up in your esophagus. This causes damage and inflammation, which can cause pain, trouble swallowing, and food getting stuck in your throat.

EoE is rare. But because it is a newly recognized disease, it is being diagnosed more often. Some people who think that they have reflux (GERD) may actually have EoE.

Researchers are not certain about the exact cause of EoE. They think that it is an immune system/allergic reaction to foods or to substances in your environment, such as dust mites, animal dander, pollen, and molds. Certain genes may also play a role in EoE.

EoE can affect anyone, but it is more common in people who:

• Are male
• Have other allergic diseases, such as hay fever, eczema, asthma and food allergies
• Have family members with EoE

The most common symptoms of EoE can depend on your age.

In infants and toddlers::

• Feeding problems
• Vomiting
• Poor weight gain and growth
• Reflux that does not get better with medicines

In older children::

• Vomiting
• Abdominal pain
• Trouble swallowing, especially with solid foods
• Reflux that does not get better with medicines
• Poor appetite

In adults::

• Trouble swallowing, especially with solid foods
• Food getting stuck in the esophagus
• Reflux that does not get better with medicines
• Heartburn
• Chest pain

To find out if you have EoE, your doctor will likely:

• Ask about your symptoms and medical history. Since other conditions can have the same symptoms of EoE, it is important for your doctor to take a thorough history.
• Do an upper gastrointestinal (GI) endoscopy. An endoscope is a long, flexible tube with a light and camera at the end of it. Your doctor will run the endoscope down your esophagus and look at it. Some signs that you might have EoE include white spots, rings, narrowing, and inflammation in the esophagus. However, not everyone with EoE has those signs, and sometimes they can be signs of a different esophagus disorder.
• Do a biopsy. During the endoscopy, the doctor will take small tissue samples from your esophagus. The samples will be checked for a high number of eosinophils. This is the only way to make a diagnosis of EoE.
• Do other tests as needed. You may have blood tests to check for other conditions. If you do have EoE, you may have blood or other types of tests to check for specific allergies.

There is no cure for EoE. Treatments can manage your symptoms and prevent further damage. The two main types of treatments are medicines and diet.

Medicines used to treat EoE are:

• Steroids, which can help control inflammation. These are usually topical steroids, which you swallow either from an inhaler or as a liquid. Sometimes doctors prescribe oral steroids (pills) to treat people who have serious swallowing problems or weight loss.
• Acid suppressors such as proton pump inhibitors (PPIs), which may help with reflux symptoms and decrease inflammation.
• Monoclonal antibodies, which can reduce inflammation and may help with swallowing. They can be used in adults and children over age 12.

Dietary changes for EoE include:

• Elimination diet. If you are on an elimination diet, you stop eating and drinking certain foods and beverages for several weeks. If you are feeling better, you add the foods back to your diet one at a time. You have repeat endoscopies to see whether or not you are tolerating those foods. There are different types of elimination diets:
• With one type, you first have an allergy test. Then you stop eating and drinking the foods you are allergic to.
• For another type, you eliminate foods and drinks that commonly cause allergies, such as dairy products, egg, wheat, soy, peanuts, tree nuts and fish/shellfish.
• Elemental diet. With this diet, you stop eating and drinking all proteins. Instead, you drink an amino acid formula. Some people who do not like the taste of the formula use a feeding tube instead. If your symptoms and inflammation go away completely, you may be able to try adding foods back one at a time, to see whether you can tolerate them.

Which treatment your doctor suggests depends on different factors, including your age. Some people may use more than one kind of treatment. Researchers are still trying to understand EoE and how best to treat it.

If your treatment is not working well enough and you have narrowing of the esophagus, you may need dilation. This is a procedure to stretch the esophagus. This makes it easier for you to swallow.

The esophagus is the muscular tube that carries food and liquids from your mouth to the stomach. You may not be aware of your esophagus until you swallow something too large, too hot, or too cold. You may also notice it when something is wrong. You may feel pain or have trouble swallowing.

The most common problem with the esophagus is GERD (gastroesophageal reflux disease). With GERD, a muscle at the end of your esophagus does not close properly. This allows stomach contents to leak back, or reflux, into the esophagus and irritate it. Over time, GERD can cause damage to the esophagus.

Other problems include heartburn, cancer, and eosinophilic esophagitis. Doctors may use various tests to make a diagnosis. These include imaging tests, an upper endoscopy, and a biopsy.

Treatment depends on the problem. Some problems get better with over-the-counter medicines or changes in diet. Others may need prescription medicines or surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

A hiatal hernia is a condition in which the upper part of your stomach bulges through an opening in your diaphragm. Your diaphragm is the thin muscle that separates your chest from your abdomen. Your diaphragm helps keep acid from coming up into your esophagus. When you have a hiatal hernia, it's easier for the acid to come up. This leaking of acid from your stomach into your esophagus is called GERD (gastroesophageal reflux disease). GERD may cause symptoms such as :

• Heartburn
• Problems swallowing
• A dry cough
• Bad breath
• Nausea and/or vomiting
• Breathing problems
• The wearing away of your teeth

Often, the cause of a hiatal hernia is unknown. It may have to do with weakness in the surrounding muscles. Sometimes the cause is an injury or a birth defect. Your risk of getting a hiatal hernia goes up as you age; they are common in people over age 50. You are also at higher risk if you have obesity or smoke.

People usually find out that they have a hiatal hernia when they are getting tests for GERD, heartburn, chest pain, or abdominal pain. The tests may be a chest x-ray, an x-ray with a barium swallow, or an upper endoscopy.

You don't need treatment if your hiatal hernia does not cause any symptoms or problems. If you do have symptoms, some lifestyle changes may help. They include eating small meals, avoiding certain foods, not smoking or drinking alcohol, and losing weight. Your health care provider may recommend antacids or other medicines. If these don't help, you may need surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Your kidneys make urine by filtering wastes and extra water from your blood. The urine travels from the kidneys to the bladder in two thin tubes called ureters.

The ureters are about 8 to 10 inches long. Muscles in the ureter walls tighten and relax to force urine down and away from the kidneys. Small amounts of urine flow from the ureters into the bladder about every 10 to 15 seconds.

Sometimes the ureters can become blocked or injured. This can block the flow of urine to the bladder. If urine stands still or backs up the ureter, you may get a urinary tract infections.

Doctors diagnose problems with the ureters using different tests. These include urine tests, x-rays, and examination of the ureter with a scope called a cystoscope. Treatment depends on the cause of the problem. It may include medicines and, in severe cases, surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Asthma is a chronic (long-term) lung disease. It affects your airways, the tubes that carry air in and out of your lungs. When you have asthma, your airways can become inflamed and narrowed. This can cause wheezing, coughing, and tightness in your chest. When these symptoms get worse than usual, it is called an asthma attack or flare-up.

The exact cause of asthma is unknown. Genetics and your environment likely play a role in who gets asthma.

An asthma attack can happen when you are exposed to an asthma trigger. An asthma trigger is something that can set off or worsen your asthma symptoms. Different triggers can cause different types of asthma:

• Allergic asthma is caused by allergens. Allergens are substances that cause an allergic reaction. They can include
  • Dust mites
  • Mold
  • Pets
  • Pollen from grass, trees, and weeds
  • Waste from pests such as cockroaches and mice
• Nonallergic asthma is caused by triggers that are not allergens, such as
  • Breathing in cold air
  • Certain medicines
  • Household chemicals
  • Infections such as colds and the flu
  • Outdoor air pollution
  • Tobacco smoke
• Occupational asthma is caused by breathing in chemicals or industrial dusts at work
• Exercise-induced asthma happens during physical exercise, especially when the air is dry

Asthma triggers may be different for each person and can change over time.

Asthma affects people of all ages, but it often starts during childhood. Certain factors can raise your risk of having asthma:

• Being exposed to secondhand smoke when your mother is pregnant with you or when you are a small child
• Being exposed to certain substances at work, such as chemical irritants or industrial dusts
• Genetics and family history. You are more likely to have asthma if one of your parents has it, especially if it's your mother.
• Race or ethnicity. Black and African Americans and Puerto Ricans are at higher risk of asthma than people of other races or ethnicities.
• Having other diseases or conditions such as obesity and allergies
• Often having viral respiratory infections as a young child
• Sex. In children, asthma is more common in boys. In teens and adults, it is more common in women.

The symptoms of asthma include:

• Chest tightness
• Coughing, especially at night or early morning
• Shortness of breath
• Wheezing, which causes a whistling sound when you breathe out

These symptoms can range from mild to severe. You may have them every day or only once in a while.

When you are having an asthma attack, your symptoms get much worse. The attacks may come on gradually or suddenly. Sometimes they can be life-threatening. They are more common in people who have severe asthma. If you are having asthma attacks, you may need a change in your treatment.

Your health care provider may use many tools to diagnose asthma:

• Physical exam
• Medical history
• Lung function tests, including spirometry, to test how well your lungs work
• Tests to measure how your airways react to specific exposures. During this test, you inhale different concentrations of allergens or medicines that may tighten the muscles in your airways. Spirometry is done before and after the test.
• Peak expiratory flow (PEF) tests to measure how fast you can blow air out using maximum effort
• Fractional exhaled nitric oxide (FeNO) tests to measure levels of nitric oxide in your breath when you breathe out. High levels of nitric oxide may mean that your lungs are inflamed.
• Allergy skin or blood tests, if you have a history of allergies. These tests check which allergens cause a reaction from your immune system.

If you have asthma, you will work with your health care provider to create a treatment plan. The plan will include ways to manage your asthma symptoms and prevent asthma attacks. It will include:

• Strategies to avoid triggers. For example, if tobacco smoke is a trigger for you, you should not smoke or allow other people to smoke in your home or car.
• Short-term relief medicines, also called quick-relief medicines. They help prevent symptoms or relieve symptoms during an asthma attack. They include an inhaler to carry with you all the time. It may also include other types of medicines which work quickly to help open your airways.
• Control medicines. You take them every day to help prevent symptoms. They work by reducing airway inflammation and preventing narrowing of the airways.

If you have a severe attack and the short-term relief medicines do not work, you will need emergency care.

Your provider may adjust your treatment until asthma symptoms are controlled.

Sometimes asthma is severe and cannot be controlled with other treatments. If you are an adult with uncontrolled asthma, in some cases your provider might suggest bronchial thermoplasty. This is a procedure that uses heat to shrink the smooth muscle in the lungs. Shrinking the muscle reduces your airway's ability to tighten and allows you to breathe more easily. The procedure has some risks, so it's important to discuss them with your provider.

Your liver makes a digestive juice called bile. Your gallbladder stores it between meals. When you eat, your gallbladder pushes the bile into tubes called bile ducts. They carry the bile to your small intestine. The bile helps break down fat. It also helps the liver get rid of toxins and wastes.

Different diseases can block the bile ducts and cause a problem with the flow of bile:

• Gallstones, which can increase pressure in the gallbladder and cause a gallbladder attack. The pain usually lasts from one to several hours.
• Cancer
• Infections
• Birth defects, such as biliary atresia. It is the most common reason for liver transplants in children in the United States.
• Inflammation, which can cause scarring. Over time, this can lead to liver failure.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases