What is Reflux?
Simply stated, reflux – or Gastro-esophageal reflux (GER) – is the regurgitation of gastric contents into the esophagus, or even higher, into the mouth or nose (lovely image, no?).
You see babies with reflux all the time. You know, babies “spitting up”. Gastro-esophageal reflux (GER) is common among infants, but it usually resolves on its own – it is estimated that 50% of 2-month-old infants have reflux of gastric contents (regurgitate, or “urp up”) at least twice per day, but only 1% of them still do it at 12 months old.
Most infants simply out-grow it. As they spend more time upright, they reflux less. For nearly all babies with reflux, it goes away without intervention. Most of these infants who are “spitty babies” do not seem bothered by this; most they don’t have symptoms.
So – for most babies with reflux – they don’t have symptoms, and it goes away by itself.
A small minority of babies will have symptoms from GER, and some do not outgrow it. When GER is abnormal, it gains the designation GERD: gastro-esophageal reflux disease.
One of the ways that reflux can show itself in babies, infants, and children is asthma. “Reactive airway disease.”
How Does Reflux Cause Asthma?
There are probably 2 mechanisms involved.
(1) The first involves inflammation from the reflux. Reflux causes inflammation of the esophagus – esophagitis.
Various biochemicals from that inflammation cause a reaction in other parts of the aero-digestive system. See my article on the Unified Airway Model for more.
(2) The second mechanism involves nerve reflexes that are triggered by the irritated esophagus – the esophagitis.
These reflexes cause bronchospasm – commonly known as asthma. There is evidence that both of these mechanisms contribute to reactive airway disease.
[Aside: although we are focused on asthma here, reflux can be a factor in rhinitis, sinusitis, otitis, and almost any “itis” of the upper airway – see future posts.]
Of course, what you want to know is:
Does MY Child Have Reflux ?
Two Common Tests:
There are several ways to look for reflux, or to look for evidence of reflux. One of the ways that we can tell that reflux is causing inflammation is to look at the esophagus – if there are inflammatory changes (esophagitis) then we consider the reflux to be a significant problem.
Back in one of the earlier studies looking for a link between respiratory symptoms and reflux, we asked, “what is the prevalence of reflux among infants and children with difficulty breathing?”
When we looked at the esophagus of infants and children who were taken to the operating room for airway evaluation (a group of children who had breathing difficulties, like severe asthma, stridor (squeaky breath sounds), apnea, recurrent pneumonias, so that endoscopy in the operating room was indicated), we found that 71% had reflux esophagitis!
That doesn’t prove that their reflux was the cause, but suggests a strong link between reflux esophagitis and breathing difficulties in babies and children.
Another way to look for reflux is to measure pH (acidity) of the esophagus over time using a pH probe – a long catheter placed through the nose into the esophagus, left in place at least 24 hours to record the pH (no, not a lot of fun). When this has been done with infants and children, multiple studies have found that episodic stridor and apnea are correlated to gastric acid refluxing into the esophagus.
One limitation of using a pH probe to diagnose reflux is that some people (especially babies and children) have non-acid reflux.
That means that the pH probe will not detect the reflux (it isn’t acidic), even though they are refluxing, and even though the reflux is causing symptoms. A newer probe that can detect even non-acid reflux is the combination pH / impedance probe. Its use is similar to the usual pH probe, just as uncomfortable.
So, if your child has asthma, is there an easy way to tell whether reflux is a factor?
Treatment as a Diagnosis
Other studies have shown that episodes of reactive airway, asthma, and wheezing all correlate with reflux by pH probe; ALL of these symptoms improved significantly after medical or surgical treatment of the reflux.
Treating children who have these breathing difficulties (for example, asthma, stridor, or apnea) for reflux can relieve their breathing symptoms.
One study found that 82% of asthmatics have reflux; 70% asthma improved by treating them for reflux.
Sounds promising, yes?
To conclude, perhaps the simplest way of finding out whether reflux is the cause of your child’s symptoms is this: treat them as if they have reflux, see whether their symptoms improve.
Next week we will review the treatments for reflux – conventional and alternative approaches.
I appreciate your comments and questions. Keep ‘em coming. Please, “be excellent to one another.”
I invite you to subscribe (it’s FREE) to this blog for weekly updates – you won’t be swamped by updates, I simply cannot write for the blog everyday.
Type in your best email address (the one you actually use). When the confirmation email from boogor doctor arrives, click on the link to give your okay to receive free weekly updates, without needing to visit the website.
It’s free, it’s convenient. No ads, no spam. You can un-subscribe at any time.
Best of health and success to you and your families.
Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor :~D)