Treating GERD

(Editor’s Note: This is the final column written by Dr. Jim Tosetti before his death in July at the age of 70. You can read about Dr. Tosetti in the First Glance column in this issue.)

Heartburn and GERD (Gastroesophageal Reflux Disease) is something we think older folks get. They just can’t tolerate certain foods, and tend to take lots of medications to help alleviate the pain.

But, they’re not the only ones with digestive problems. Approximately seven million children and youngsters under the age of 17 in the United States suffer from GERD, which occurs when the valve between the esophagus and stomach becomes weak. Normally this valve opens to allow food in and then shuts tightly, right on cue. With GERD, the valve stays open, allowing stomach acids to flow back up into the esophagus, and causing heartburn and many other symptoms.

Look for Symptoms
There’s a name for the disease—Pediatric GERD—and symptoms may include colic, inconsolable crying, frequent spitting up and refusal to eat, failure to thrive, heartburn, stomach pains, chronic sore throat, chronic respiratory problems, asthma and apnea (not breathing). Some may have subtle signs that can be misinterpreted as simply being fussy.
Sometimes the symptoms occur as the child grows older. These problems can include bad breath, disinterest in food, a need to drink soothing liquids constantly, problems maintaining a reasonable weight, regurgitation of food, difficulty swallowing, asthma, bronchitis, sinus and ear infections, hoarse voice, coughing and a choking sensation (especially at night), salivating more than normal and damage to tooth enamel.

Ongoing symptoms like these should never be ignored. Immediate medical attention is the best form of action, whether this is happening to your baby or teen-ager. It’s so important to be a good observer, which most parents are. They can tell when their baby or child is “off” on any certain day. This doesn’t mean being obsessive when the slightest little burp comes up, but it does mean watching for symptoms and behaviors over a period of time.

It’s also important to be a good listener. Sometimes children fabricate all sorts of tales to avoid going to school or to stay out of certain situations. We’ve all done this ourselves, so it’s wise to be aware of what tales they can weave. But, there really could be something wrong. Listen to their complaints. Ask questions. Keep a journal of what’s going on so you can relay this information to the doctor.

Treatment Options
What causes GERD? Genetics seem to be a big factor, but it can also be caused by allergies and intolerance to certain medications. Many people with digestive disorders such as slow intestinal movement or intolerance to wheat can have reflux problems.

How do you treat GERD? Your doctor will take a history and run some tests. You’ll learn about avoiding certain foods and what triggers the situation. You’ll learn that exercising or lying down on a full stomach often increases reflux and should be avoided. Many people sleep with elevated pillows (some even raise up the head of the bed).

Spicy foods should be avoided or reduced, and you should stay away from beverages that contain caffeine, chocolate, peppermint, and spearmint. Hopefully your teen-agers aren’t drinking alcohol or smoking, but having GERD is another good important reason to say no. Stay away from carbonated drinks, too. Do eat a diet rich in fruits and vegetables, but try to avoid those acidic ones like oranges, lemons, grapefruit, pineapple and tomatoes.

Your doctor will give you plenty of information and suggestions for following a healthy diet, and most probably will put you in touch with a dietitian who can also provide all sorts of good menu ideas.

The doctor will probably prescribe antacids and possible medications to help ease the pain and discomfort. Remember, it’s not all about taking a pill. Lifestyle changes are just as important as reaching for the medicine bottle.

Neutralize Acid
Chewing gum has been a topic of debate with many health professionals over the years. Some agree it helps relieve the symptoms of acid reflux because there’s an increase of saliva production, and it’s slightly alkaline, which helps neutralize the acid in the esophagus. If the patient does chew gum, make sure it’s sugar-free gum. No sense bringing on dental problems with an increase of sugar.

Relieving added complications from GERD can be helped by also losing some extra pounds. Being overweight likely causes increased pressure from the stomach to be exerted on the esophageal sphincter. Reducing one’s fat content with a healthy diet also helps speed gastric emptying, so that acid won’t stick around. Don’t eat right before bed either. You want to minimize the amount of acid in your stomach when lying down.

Laparoscopic surgery may be an option if medication and other treatments don’t help. This is something to talk about with your doctor. Ask questions and learn all that you can about the procedure and recovery time.

Childhood Issues
For any child or teen-ager, having health complications can add extra stress, especially when they’re at school or out with their friends. Constantly worrying about that distasteful and irritating sensation that could come at any moment is difficult for some youngsters, so they may tend to shy away from certain situations. Be there for them with support and understanding. Let them talk about the situation, about their feelings and fears, and let them be part of the treatment process with the doctor.

For more information, check out this very interesting Web site of the Pediatric Adolescent Gastroesophageal Reflux Association (PAGER): www.reflux.org It’s chock-full of pertinent information on symptoms, treatment, diagnostic tests and medications, plus it also provides an excellent forum for you to share your experiences and learn from others.

Here’s to you health!