• Endoscopy. A sedative is given before this procedure to make the child sleepy. A small, flexible tube with a very tiny camera on the end is then inserted through the mouth and esophagus and into the stomach. The camera gives the doctor a view of the lining of the esophagus, stomach, and small intestine by transmitting the images onto a television screen. During the endoscopy, the doctor can also remove a small piece of tissue in a procedure called a biopsy. Looking at the tissue with a microscope helps the doctor determine the level of acid damage and rule out problems.

• Esophageal pH probe. A thin, light wire with an acid sensor at its tip is inserted through the nose into the lower part of the esophagus. This probe detects and records the amount of stomach acid coming back up into the esophagus and indicates whether acid is in the esophagus when the child has symptoms such as crying, coughing, or arching her back.

What is the treatment for GER?

Treatment for reflux depends on the child’s symptoms and age. The doctor or nurse may first suggest a trial of medication to decrease the amount of acid made in the stomach when a child or teenager is uncomfortable, has difficulty sleeping or eating, or fails to grow.

^*  H2-blockers, which are also called H2- receptor agonists, are one class of medication often tried first. These drugs help keep acid from backing up into the esophagus. They are often used to treat children with GER because they come in liquid form. H2-blockers include

• cimetidine (Tagamet)
• ranitidine (Zantac)
• famotidine (Pepcid)
• nizatidine (Axid)

A second class of medications often used to reduce stomach acid is proton-pump inhibitors (PPIs), which block the production of stomach acid. PPIs have few side effects, but those that have been reported are constipation, nausea, and headaches. This class of drugs includes

• esomeprazole (Nexium)
• omeprazole (Prilosec)
• lansoprazole (Prevacid)
• rabeprazole (Aciphex)
• pantoprazole (Protonix)

A third class of medications used to treat GER is prokinetic agents. Prokinetic agents make the LES close tighter so stomach acid cannot reflux into the esophagus. These drugs are often used in combination with acid reducers. Prokinetic agents include

• metoclopramide (Reglan)
• cisapride (Propulsid)
• erythromycin (Dispertab, Robimycin)
• bethanechol (Duvoid, Urecholine)

Serious side effects have been reported in adults and children taking metoclopramide and cisapride, including confusion, anxiety, diarrhea, and nausea. People taking prokinetic agents should tell their doctor if they are taking other medications because there could be an adverse drug reaction.

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