Pediatric Nutrition: William J. Klish

My pediatrician says my 3-month-old is suffering from reflux and recommended we see a gastroenterologist. What can I expect from this visit? Will he prescribe a medication to treat it?

By William Klish, M.D.

What the gastroenterologist will do depends upon the severity of the reflux. Most reflux is a benign, self-limited condition in infants that does not require any specific therapy. It is believed to be caused by incomplete development of the sphincter or valve between the stomach and esophagus. This sphincter continues to develop after birth so most infants with this condition stop refluxing by 6 to 9 months of age. Treatment other than mechanical ones, such as positioning of the baby during feeds and adding cereal to formula or pumped breastmilk, is usually not necessary or particularly effective. However, if the reflux is causing complications such as esophagitis due to acid irritation of the esophagus, growth failure due to loss of calories from the spitting, or pneumonia due to aspiration of the refluxed material, tests and other treatment may be necessary. If the gastroenterologist suspects esophagitis he may want to do an endoscopy to evaluate the esophagus. He may also want to perform a 24-hour esophageal pH probe to correlate lung symptoms with reflux. Both these tests are fairly routine and done as an outpatient.

In some cases, the gastroenterologist may suggest medication. The two types used are medicines to block acid secretion (such as ranitidine or omeprasole) and those that enhance stomach emptying (such as metaclopramide or bethanecol). In my experience, these medicines don't usually change the amount of reflux and parents wind up stopping them and just waiting for the baby to mature. If serious complications are diagnosed, such as aspiration pneumonia, it may be necessary to surgically tighten the esophageal sphincter to protect the baby's health.

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