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GER vs. GERD Can Be Compared to Dr. Jekyll and Mr. Hyde

Jan 03, 2018 11:32AM ● By The Hood Magazine

It is the medical equivalent of Dr. Jekyll and Mr. Hyde. One condition is relatively benign; its closely-related alter ego is more sinister.

“There is a very thin line between GER and GERD,” says Andrew Huang, M.D., Children’s Specialty Physicians, Gastroenterology, Children’s Hospital & Medical Center and an assistant professor of Gastroenterology at UNMC College of Medicine.

Gastroesophageal reflux (GER), also known as acid reflux, is “normal;” the result of stomach contents refluxing into one’s esophagus. A typical adult can have about 80 episodes a day, most of which go unnoticed. Most babies spit up a few times a day and most outgrow this by the time they are 18 months old. Children and teens also will experience GER from time to time.

Gastroesophageal reflux disease (GERD), on the other hand, is GER to an extreme: chronic, more frequent and capable of causing serious complications if left untreated.

“This is the part,” says Dr. Huang, “where medicine transitions from being a science to becoming an art: How do you differentiate one from the other – and how do you best manage those patients who require more treatment and a more surgical or procedural approach?”

In other words – when does Dr. Jekyll become Mr. Hyde?

“GER becomes abnormal when there are other problems associated with it,” Dr. Huang explains.

These problems include:

●     Failure to thrive/reach milestones

●     Frequent vomiting, including bloody vomiting

●     Dysphagia

●     Recurrent infections, especially upper respiratory and lower respiratory infections

●     Associated neurological symptoms such as movement disorders or developmental delay

●     Any association with an apparent life-threatening episode (ALTE) now also known as BRUE (Brief Resolved Unexplained Event)

An infant may have GERD if symptoms prevent him or her from feeding, such as vomiting, gagging, coughing and trouble breathing; or if the infant has GER for more than 18 months.

Potential GERD complications include:

●     Asthma

●     Problems with weight gain

●     Poor nutrition

●     Inflammation of the esophagus (esophagitis)

●     Esophageal sores or ulcers

Diagnosing GERD

“We use ancillary and radiologic tests to help us make a correlation between the reflux and other problems, such as aspiration, pneumonia, failure to thrive and even neurological problems,” he explains. “A cow’s milk protein allergy or intolerance is one of the problems we look for in patients with GERD. We also look for gastric emptying problems, anatomical abnormalities that can be surgically corrected and other manifestations of reflux, such as eosinophilic esophagitis.”

Treating GERD

“Once you have associated GERD with failure-to-thrive infants, you have to make sure the patient is able to keep down the majority of the feedings, that we are reaching milestones adequately and that we are making sure the infant is not malnourished,” Dr. Huang says.

In many cases, diet and lifestyle changes can help ease GERD. For babies, this may include a formula change, adding rice cereal to thicken the formula or breast milk and avoiding over-feeding. Older children should be offered smaller portions at mealtimes and avoid fried and fatty foods, peppermint, chocolate, tomato products, caffeinated drinks and citrus fruit and juices.

Medications may help with reflux. Histamine-2 (H2) blockers and proton pump inhibitors may be prescribed.

When surgery is deemed necessary, “we work closely with our colleagues in pediatric surgery either by placing gastrostomy tubes, gastrojejunostomy tubes or even taking patients in for fundoplication. If the patient also has an upper respiratory anatomical problem, we work with pulmonary and ENT,” Dr. Huang says. “The management of refractory GERD or difficult-to-treat GERD should be multidisciplinary. We work closely with several other specialties to provide the best care for our patients.”

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