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Acid Reflux (GER & GERD) in Children

Table of Contents

Acid Reflux (GER & GERD) in Children

Reflux in Children; GER in Children; GERD in Children

Children can get gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD), which happen when stomach contents leak back up into their esophagus. Learn the difference between GER and GERD, and about common symptoms and treatments.

Young child eating

Image by hadesdaiphat

Definition & Facts

Gastroesophageal reflux disease - What causes GER and GERD?

Image by BruceBlaus

Gastroesophageal reflux disease - What causes GER and GERD?

Gastroesophageal Reflux Disease (GERD)

Image by BruceBlaus

Definition & Facts for GER & GERD in Children

What is GER?

Gastroesophageal reflux (GER) happens when stomach contents come back up into the esophagus. Many people, including children between 1 and 18 years old, have GER once in a while. GER often happens without causing symptoms. In some cases, GER may cause

heartburn, also called acid indigestion
regurgitation, or stomach contents coming up through the esophagus and into the throat or mouth

Does GER have another name?

Doctors also refer to GER as

acid indigestion
acid reflux
acid regurgitation
heartburn
reflux

How common is GER in children?

Having GER once in a while is common.

What is GERD?

Gastroesophageal reflux disease (GERD) is a more severe and long-lasting condition in which GER causes repeated symptoms that are bothersome or leads to complications over time. The symptoms of GERD in older children and teens may be similar to the symptoms of GERD in adults. However, signs and symptoms of GERD in younger children may be different.

If you think your child has GERD, you should take him or her to see a doctor or pediatrician.

How common is GERD in children?

Few large studies have examined how common GERD is in children. Research suggests that about 10 percent of children may have GERD symptoms at least once a week.¹ Research also suggests that GERD is more common among children age 10 and older than among younger children.

Which children are more likely to have GERD?

Any child can have GERD. GERD is more common in children who are overweight, have obesity, or have a large waist size. Children with certain health conditions that affect the esophagus, nervous system, or lungs are also more likely to have GERD.

What are the complications of GERD in children?

Without treatment, GERD can sometimes cause serious complications over time. A pediatrician should monitor children with GERD to prevent or treat long-term problems, such as esophagitis, esophageal stricture, and Barrett’s esophagus, as well as complications outside the esophagus.

Esophagitis

Esophagitis is inflammation in the esophagus. Esophagitis may cause ulcers in the lining of the esophagus and bleeding. Chronic esophagitis increases the chance of developing esophageal stricture and Barrett’s esophagus.

Esophageal stricture

An esophageal stricture happens when the esophagus becomes too narrow. Esophageal strictures can lead to problems with swallowing.

Barrett’s esophagus

GERD can sometimes lead to Barrett’s esophagus, a condition in which tissue that is similar to the lining of the intestine replaces the tissue lining the esophagus. A small number of people with Barrett’s esophagus develop a type of cancer called esophageal adenocarcinoma.

Complications outside the esophagus

Some children with GERD also have complications in the mouth, throat, or lungs. These complications may include

asthma
chronic cough
hoarseness
laryngitis—inflammation of the voice box that can lead to a short-term loss of voice
pneumonia that keeps coming back
wearing away of tooth enamel
wheezing—a high-pitched whistling sound that happens while breathing

Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Additional Materials (6)

Pediatric Fundoplication for Gastroesophageal Reflux Disease (GERD)

Video by Covenant Health/YouTube

GERD in Children

Video by AllHealthGo/YouTube

What is GERD?

Video by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)/YouTube

When a Child or Teen Has Gastroesophageal Reflux Disease (GERD) - Dr. Mitchell Katz

Video by CHOC Children's/YouTube

Understanding Reflux in Kids | Boston Children's Hospital

Video by Boston Children's Hospital/YouTube

Ask-a-Doc | How to tell if baby’s spit up is normal or acid reflux | Cook Children's

Video by Cook Children's Health Care System/YouTube

4:31

Pediatric Fundoplication for Gastroesophageal Reflux Disease (GERD)

Covenant Health/YouTube

2:36

GERD in Children

AllHealthGo/YouTube

1:17

What is GERD?

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)/YouTube

2:11

When a Child or Teen Has Gastroesophageal Reflux Disease (GERD) - Dr. Mitchell Katz

CHOC Children's/YouTube

2:03

Understanding Reflux in Kids | Boston Children's Hospital

Boston Children's Hospital/YouTube

0:51

Ask-a-Doc | How to tell if baby’s spit up is normal or acid reflux | Cook Children's

Cook Children's Health Care System/YouTube

Reflux in Children

Obesity & Gastroesophageal Reflux Disease (GERD)

Image by TheVisualMD

Obesity & Gastroesophageal Reflux Disease (GERD)

A figure with visible gastrointestinal tract is shown to compare a healthy esophagus and an inflamed esophagus due to erosion by stomach acid in a condition known as gastroesophageal reflux disease (GERD). GERD is a disorder in which the sphincter muscle at the base of the esophagus relaxes at the wrong time, causing stomach acid to flow backwards into the esophagus. The acid irritates and inflames the lining of the esophagus, causing a burning sensation. Changes in diet and lifestyle can help reduce or eliminate symptoms of GERD and also lower the risk of developing the disease in the first place.

Image by TheVisualMD

Reflux in Children

What are reflux (GER) and GERD?

The esophagus is the tube that carries food from your mouth to your stomach. If your child has reflux, his or her stomach contents come back up into the esophagus. Another name for reflux is gastroesophageal reflux (GER).

GERD stands for gastroesophageal reflux disease. It is a more serious and long-lasting type of reflux. If your child has reflux more than twice a week for a few weeks, it could be GERD.

What causes reflux and GERD in children?

There is a muscle (the lower esophageal sphincter) that acts as a valve between the esophagus and stomach. When your child swallows, this muscle relaxes to let food pass from the esophagus to the stomach. This muscle normally stays closed, so the stomach contents don't flow back into the esophagus.

In children who have reflux and GERD, this muscle becomes weak or relaxes when it shouldn't, and the stomach contents flow back into the esophagus. This can happen because of

A hiatal hernia, a condition in which the upper part of your stomach pushes upward into your chest through an opening in your diaphragm
Increased pressure on the abdomen from being overweight or having obesity
Medicines, such as certain asthma medicines, antihistamines (which treat allergies), pain relievers, sedatives (which help put people to sleep), and antidepressants
Smoking or exposure to secondhand smoke
A previous surgery on the esophagus or upper abdomen
A severe developmental delay
Certain neurological conditions, such as cerebral palsy

How common are reflux and GERD in children?

Many children have occasional reflux. GERD is not as common; up to 25% of children have symptoms of GERD.

What are the symptoms of reflux and GERD in children?

Your child might not even notice reflux. But some children taste food or stomach acid at the back of the mouth.

In children, GERD can cause

Heartburn, a painful, burning feeling in the middle of the chest. It is more common in older children (12 years and up).
Bad breath
Nausea and vomiting
Problems swallowing or painful swallowing
Breathing problems
The wearing away of teeth

How do doctors diagnose reflux and GERD in children?

In most cases, a doctor diagnoses reflux by reviewing your child's symptoms and medical history. If the symptoms do not get better with lifestyle changes and anti-reflux medicines, your child may need testing to check for GERD or other problems.

Several tests can help a doctor diagnose GERD. Sometimes doctors order more than one test to get a diagnosis. Commonly-used tests include

Upper GI series, which looks at the shape of your child's upper GI (gastrointestinal) tract. You child will drink a contrast liquid called barium. For young children, the barium is mixed in with a bottle or other food. The health care professional will take several x-rays of your child to track the barium as it goes through the esophagus and stomach.
Esophageal pH and impedance monitoring, which measures the amount of acid or liquid in your child's esophagus. A doctor or nurse places a thin flexible tube through your child's nose into the stomach. The end of the tube in the esophagus measures when and how much acid comes back up into the esophagus. The other end of the tube attaches to a monitor that records the measurements. Your child will wear the tube for 24 hours. He or she may need to stay in the hospital during the test.
Upper gastrointestinal (GI) endoscopy and biopsy, which uses an endoscope, a long, flexible tube with a light and camera at the end of it. The doctor runs the endoscope down your child's esophagus, stomach, and first part of the small intestine. While looking at the pictures from the endoscope, the doctor may also take tissue samples (biopsy).

What lifestyle changes can help treat my child's reflux or GERD?

Sometimes reflux and GERD in children can be treated with lifestyle changes:

Losing weight, if needed
Eating smaller meals
Avoiding high-fat foods
Wearing loose-fitting clothing around the abdomen
Staying upright for 3 hours after meals and not reclining and slouching when sitting
Sleeping at a slight angle. Raise the head of your child's bed 6 to 8 inches by safely putting blocks under the bedposts.

What treatments might the doctor give for my child's GERD?

If changes at home do not help enough, the doctor may recommend medicines to treat GERD. The medicines work by lowering the amount of acid in your child's stomach.

Some medicines for GERD in children are over-the-counter, and some are prescription medicines. They include

Over-the-counter antacids
H2 blockers, which decrease acid production
Proton pump inhibitors (PPIs), which lower the amount of acid the stomach makes
Prokinetics, which help the stomach empty faster

If these don't help and your child still has severe symptoms, then surgery might be an option. A pediatric gastroenterologist, a doctor who treats children who have digestive diseases, would do the surgery.

Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Causes

Consequences of Childhood Obesity

Image by TheVisualMD

Consequences of Childhood Obesity

Consequences of Childhood Obesity : Even though overweight kids tend to have denser bones, they have more bone fractures than nonoverweight children. This may be because being overweight interferes with balance and also because overweight children fall with greater force.

Image by TheVisualMD

What Causes GER and GERD in Children?

The lower esophageal sphincter and diaphragm most often prevent GER, which is when stomach contents come back up into the esophagus. However, having GER once in a while is common.

GERD may develop if the lower esophageal sphincter becomes weak or relaxes when it shouldn’t, which may occur due to

being overweight, having obesity, or having a large waist size
inhaling secondhand smoke
factors that are more common in teens, such as smoking or pregnancy

Children are more likely to have GERD if they have health conditions that affect the upper GI tract, including

conditions that affect the nervous system, such as cerebral palsy
conditions that affect the lungs, such as cystic fibrosis
hiatal hernia, a condition in which the opening in the diaphragm lets the upper part of the stomach move up into the chest
previous surgery to correct esophageal atresia, a type of birth defect

Some medicines can cause GERD or make GERD symptoms worse. Talk with your child’s doctor about any medicines he or she takes and whether those medicines could play a role in GERD.

Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Additional Materials (2)

Understanding Reflux in Kids | Boston Children's Hospital

Video by Boston Children's Hospital/YouTube

Hiatal Hernia

Image by BruceBlaus

2:03

Understanding Reflux in Kids | Boston Children's Hospital

Boston Children's Hospital/YouTube

Hiatal Hernia

BruceBlaus

Symptoms

Gastroesophageal reflux disease

Image by TheVisualMD

Gastroesophageal reflux disease

Gastroesophageal Reflux Disease (GERD) : A figure with visible gastrointestinal tract is shown to compare a healthy esophagus and an inflamed esophagus due to erosion by stomach acid in a condition known as gastroesophageal reflux disease (GERD). GERD is a disorder in which the sphincter muscle at the base of the esophagus relaxes at the wrong time, causing stomach acid to flow backwards into the esophagus. The acid irritates and inflames the lining of the esophagus, causing a burning sensation. Changes in diet and lifestyle can help reduce or eliminate symptoms of GERD and also lower the risk of developing the disease in the first place.

Image by TheVisualMD

What Are the Symptoms of GER and GERD in Children?

Symptoms of gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) vary by age among children. Symptoms of GER and GERD in older children and teens may be similar to symptoms in adults. Symptoms in young children may be more similar to those seen in infants.

GER and GERD commonly cause symptoms such as

heartburn, a painful, burning feeling in the middle of the chest, behind the breastbone, rising from the lower tip of the breastbone toward the throat. Heartburn is more common in older children and teens than in young children.
regurgitation, or stomach contents coming back up through the esophagus and into the throat or mouth, which may cause a child to taste food or stomach acid. Vomiting may occur along with regurgitation.

However, not all children with GER or GERD have heartburn or regurgitation. Other symptoms may include

nausea
pain in the chest or the upper part of the abdomen
problems swallowing or pain while swallowing
symptoms of complications in the mouth, throat, or lungs, such as cough, hoarseness, or wheezing

In children who are too young to describe their symptoms well, parents may notice signs of GER or GERD such as

arching of the back and abnormal movements of the neck and chin
irritability or crying more than usual
loss of appetite or refusing to eat
poor growth, weight loss, or gaining less weight than expected

Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Additional Materials (2)

Kids get acid reflux too

Video by WXYZ-TV Detroit | Channel 7/YouTube

How to Reduce Your Baby's Reflux | Parents

Video by Parents/YouTube

2:34

Kids get acid reflux too

WXYZ-TV Detroit | Channel 7/YouTube

1:14

How to Reduce Your Baby's Reflux | Parents

Parents/YouTube

When Should I Seek a Doctor's Help?

GERD

Image by TheVisualMD

GERD

A figure with visible gastrointestinal tract is shown to compare a healthy esophagus and an inflamed esophagus due to erosion by stomach acid in a condition known as gastroesophageal reflux disease (GERD). GERD is a disorder in which the sphincter muscle at the base of the esophagus relaxes at the wrong time, causing stomach acid to flow backwards into the esophagus. The acid irritates and inflames the lining of the esophagus, causing a burning sensation. Changes in diet and lifestyle can help reduce or eliminate symptoms of GERD and also lower the risk of developing the disease in the first place.

Image by TheVisualMD

When Should I Seek a Doctor's Help for My Child's Acid Reflux Issues?

Call a doctor right away if your child has signs or symptoms that could be related to a serious health problem other than GERD or a GERD complication. Examples include

problems breathing
problems swallowing or pain while swallowing
refusing food repeatedly, causing weight loss or poor growth
signs of bleeding in the digestive tract, such as
- vomit that contains blood or looks like coffee grounds
- rectal bleeding or stool that contains blood
signs of dehydration, such as no tears when he or she cries
vomiting
- in large amounts
- that is regularly forceful, also called projectile vomiting
- with bile in the vomit, which makes the vomit green or yellow in color

Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Additional Materials (1)

When a Child or Teen Has Gastroesophageal Reflux Disease (GERD) - Dr. Mitchell Katz

Video by CHOC Children's/YouTube

2:11

When a Child or Teen Has Gastroesophageal Reflux Disease (GERD) - Dr. Mitchell Katz

CHOC Children's/YouTube

Diagnosis

Endoscopy

Image by National Cancer Institute / Linda Bartlett (Photographer)

Endoscopy

Instruments used in endoscopy. They are highlighted in an otherwise dark setting and lying on a textured cloth. Flexible fibers, a small brush and a third instrument. The fibers transmit high intensity light through the endoscope shown. The brushes are used to take biopsies.

Image by National Cancer Institute / Linda Bartlett (Photographer)

How Is GER and GERD Diagnosed in Children?

How do doctors diagnose GER and GERD in children?

In most cases, doctors diagnose gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) by reviewing a child’s symptoms and medical history. If symptoms suggest GERD, doctors may recommend treatment with lifestyle changes or medicines, instead of doing tests.

Doctors may recommend medical tests if symptoms suggest that a child may have a health problem other than GERD or a complication of GERD. Doctors may also recommend tests if symptoms don’t improve with lifestyle changes or medicines.

Doctors may refer a child to a pediatric gastroenterologist to diagnose and treat GERD.

What tests do doctors use to diagnose GERD?

Doctors may order one or more of the following tests to help diagnose GERD and check for other health problems.

Upper gastrointestinal (GI) endoscopy

Upper GI endoscopy is a procedure in which a doctor uses an endoscope—a flexible tube with a camera—to see the lining of the upper GI tract, including the esophagus, stomach, and duodenum. During upper GI endoscopy, a doctor may obtain biopsies by passing an instrument through the endoscope to take small pieces of tissue from the lining of the esophagus. A pathologist will examine the tissue under a microscope. Doctors may order an upper GI endoscopy to check for problems other than GERD or complications of GERD.

Esophageal pH monitoring

Esophageal pH monitoring is the most accurate way to detect stomach acid in the esophagus. Two types of esophageal pH monitoring are

catheter monitoring, in which a health care professional passes one end of a catheter—a thin, flexible tube—through the nose and into the esophagus to measure acid reflux. Health care professionals sometimes combine this test with an impedance monitoring test, which can detect nonacid reflux, during the same procedure.
capsule monitoring, in which a health care professional uses an endoscope to place a small, wireless capsule on the lining of the esophagus to measure acid reflux.

The child wears a monitor that receives information from the catheter or capsule. During esophageal pH monitoring, a parent or caregiver tracks information about the child’s diet, sleep, and symptoms. The doctor uses this information to see how diet, sleep, and symptoms relate to reflux in the esophagus. Doctors may order this test to confirm the diagnosis of GERD or to find out if GERD treatments are working.

Upper GI series

An upper GI series is a procedure in which a doctor uses x-rays and a chalky liquid called barium to view the upper GI tract. Doctors may order this test to check for problems, such as anatomic problems in the upper GI tract, that may be causing or worsening symptoms.

Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Upper GI Endoscopy

Upper GI Endoscopy

Also called: Esophagogastroduodenoscopy, EGD, Gastroscopy, Upper Endoscopy

Upper GI endoscopy, or gastroscopy, is a test to examine the inside of your throat, food pipe (esophagus) and stomach, known as the upper part of your digestive system. It can also be used to remove tissue for testing (biopsy) and treat some conditions such as stomach ulcers.

Upper GI Endoscopy

Also called: Esophagogastroduodenoscopy, EGD, Gastroscopy, Upper Endoscopy

Upper GI endoscopy, or gastroscopy, is a test to examine the inside of your throat, food pipe (esophagus) and stomach, known as the upper part of your digestive system. It can also be used to remove tissue for testing (biopsy) and treat some conditions such as stomach ulcers.

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Use the slider below to see how your results affect your health.
Your result is Normal.
A normal upper GI endoscopy means that the esophagus, stomach, and duodenum (upper small intestine) look normal. There is no bleeding, growths, ulcers, or inflammation.
Related conditions
You may need this test to:
- find the cause of unexplained symptoms, such as ongoing pain or heartburn, vomiting, or problems swallowing
- identify diseases and health conditions, such as gastroesophageal reflux disease, celiac disease, or cancer and Barrett’s esophagus
- find the cause of an infection, such as helicobacter pylori (H. pylori)
- check the healing of stomach ulcers
- look for a blockage in the opening between the stomach and duodenum
Some results from an upper GI endoscopy are available right away. If your doctor took samples of tissue, cells, or fluid during the procedure, a pathologist will examine the samples. These results can take a few days or longer to come back.
1. Upper GI Endoscopy - NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Feb 7, 2024 [accessed on Feb 07, 2024]
2. EGD - esophagogastroduodenoscopy: MedlinePlus Medical Encyclopedia [accessed on Feb 07, 2024]
3. Gastroscopy procedure: MedlinePlus Medical Encyclopedia Image [accessed on Feb 07, 2024]
4. Upper Gastrointestinal Endoscopy [accessed on Feb 07, 2024]
5. Gastroscopy - NHS. nhs.uk. Feb 7, 2024 [accessed on Feb 07, 2024]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (18)

Sensitive content

This media may include sensitive content

Esophageal varices

Endoscopy image of bleeding esophageal varices being banded. Clearly seen are the longitudinal wale signs on the banded varix. Note the colour change in the banded varix to an off-white shade, indicating that it is devoid of blood within.

Image by Samir

What is bleeding in the digestive tract? Gastrointestinal bleeding

The Blakemore esophageal balloon used for stopping esophageal bleeds if other measures have failed

Image by Olek Remesz (wiki-pl: Orem, commons: Orem)

Esophageal disease

Esophagus, Stomach, Small Intestine

Image by National Cancer Institute

Sensitive content

This media may include sensitive content

Esophageal cancer

Endoscopy and radial endoscopic ultrasound images of a submucosal tumor in the central portion of the esophagus

Image by Samir at English Wikipedia

Esophageal Cancer

Endoscopic image of an esophageal adenocarcinoma

Image by Samir

Diagram showing oesophageal cancer that has spread (M staging)

Diagram showing oesophageal cancer that has spread (M staging).

Image by Cancer Research UK / Wikimedia Commons

Esophageal cancer

Self-expandable metallic stents are sometimes used for palliative care

Image by Samir

Esophageal cancer

Esophageal stent for esophageal cancer

Image by James Heilman, MD

Sensitive content

This media may include sensitive content

Mallory-Weiss syndrome

Endoscopic image of Mallory-Weiss tear

Image by Samir

Gastroscopy or duodenoscopy

Gastroscopy or duodenoscopy is performed for a number of indications, one of the most common being in unexplained anemia where it is used to diagnose gastric or duodenal ulcers among other things.

Image by CNX OpenStax

Preparing for a Capsule Endoscopy - from the American Gastroenterological Association

Video by AmerGastroAssn/YouTube

Stomach Cancer: Diagnosis & Treatment | Los Angeles Endoscopy

Video by Los Angeles Colonoscopy/YouTube

Air and Food Pathways

Normal pathways for air and food in the body with the following parts labeled: epiglottis, larynx, esophagus, trachea, lung, and stomach.

Image by Alan Hoofring (Illustrator) National Cancer Institute

Upper GI Endoscopy Procedure in the ED

Video by Larry Mellick/YouTube

Upper GI Endoscopy at Cook Children's

Video by Cook Children's Health Care System/YouTube

Upper endoscopy: Guide for children

Video by Children's Wisconsin/YouTube

Having an endoscopy | Cancer Research UK

Video by Cancer Research UK/YouTube

PreOp® Patient Education GI Endoscopy - Upper GI 1

Video by PreOp.com Patient Engagement - Patient Education/YouTube

Sensitive content

This media may include sensitive content

Esophageal varices

Samir

What is bleeding in the digestive tract? Gastrointestinal bleeding

Olek Remesz (wiki-pl: Orem, commons: Orem)

Esophageal disease

National Cancer Institute

Sensitive content

This media may include sensitive content

Esophageal cancer

Samir at English Wikipedia

Esophageal Cancer

Samir

Diagram showing oesophageal cancer that has spread (M staging)

Cancer Research UK / Wikimedia Commons

Esophageal cancer

Samir

Esophageal cancer

James Heilman, MD

Sensitive content

This media may include sensitive content

Mallory-Weiss syndrome

Samir

Gastroscopy or duodenoscopy

CNX OpenStax

8:50

Preparing for a Capsule Endoscopy - from the American Gastroenterological Association

AmerGastroAssn/YouTube

4:57

Stomach Cancer: Diagnosis & Treatment | Los Angeles Endoscopy

Los Angeles Colonoscopy/YouTube

Air and Food Pathways

Alan Hoofring (Illustrator) National Cancer Institute

5:02

Upper GI Endoscopy Procedure in the ED

Larry Mellick/YouTube

2:31

Upper GI Endoscopy at Cook Children's

Cook Children's Health Care System/YouTube

2:55

Upper endoscopy: Guide for children

Children's Wisconsin/YouTube

1:20

Having an endoscopy | Cancer Research UK

Cancer Research UK/YouTube

1:50

PreOp® Patient Education GI Endoscopy - Upper GI 1

PreOp.com Patient Engagement - Patient Education/YouTube

Esophageal PH Test

Esophageal PH Test

Also called: Esophageal pH monitoring 24-hour, Esophageal pH study, Esophageal reflux monitoring, Esophageal acidity test, Esophageal pH exam

An esophageal pH test measures how often stomach acid enters the esophagus and how long the acid stays there. It's most often used to diagnose GERD, a disorder that happens when stomach acid flows back into the esophagus.

Esophageal PH Test

Also called: Esophageal pH monitoring 24-hour, Esophageal pH study, Esophageal reflux monitoring, Esophageal acidity test, Esophageal pH exam

An esophageal pH test measures how often stomach acid enters the esophagus and how long the acid stays there. It's most often used to diagnose GERD, a disorder that happens when stomach acid flows back into the esophagus.

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Use the slider below to see how your results affect your health.
pH
4
Your result is Normal.
The esophageal pH test records the level of acidity escaping the stomach over a period of time. These measurements are then analyzed and compared to normal levels of acidity. It is normal for the test to show a small amount of acid seeping into the esophagus at various times during the day and night.
Related conditions
You may need this test if you have symptoms of acid reflux. These include:
- Heartburn
- Swallowed food coming back into your mouth (regurgitation)
- Trouble swallowing
- Feeling a lump in your throat
- Sore throat
- Cough
- Frequent burping
An esophageal pH test may be done using a thin tube called a catheter or with a wireless pH probe (a small, capsule-like device).
During a catheter test:
- Your health care provider will insert a small, thin tube through your mouth or nose. One end of the tube will extend down to your esophagus. The tube has a sensor that measures your acid level.
- The other end of the tube will be connected to a small monitor that you wear around your waist or over your shoulder.
- The monitor will measure your acid levels for 24 hours.
- You will keep a diary of your symptoms and the food you eat during these 24 hours.
- The next day, you will see your provider, who will remove the tube and monitor. You'll also give your provider the diary of your symptoms and food eaten.
During a wireless test, also known as a pH probe study:
- Your provider will attach a pH probe to the lining of your esophagus during an upper endoscopy, a procedure that is done using an endoscope. An endoscope is a thin, tube-like instrument with a light and camera.
- You will get a medicine to block the pain and make you feel relaxed and sleepy during the procedure.
- The probe will measure acid levels for 48 to 96 hours.
- The probe will send the information to a device you wear on your wrist or belt.
- You will need to keep a diary of your symptoms and food you eat for 48 to 96 hours.
- In 4 to 10 days, the probe will leave your body through a bowel movement.
- After the probe stops transmitting (after 48-96 hours), you will give the diary to your provider.
If your results show high acid levels, it may mean you have one of the following conditions:
- Acid reflux
- GERD
- Esophagitis, a condition that cause swelling and/or inflammation of the esophagus. It can cause difficulty swallowing.
- Stricture, a narrowing of the esophagus that can make it hard to swallow and cause breathing problems
- Barrett's esophagus, a condition that affects the lining of the esophagus. It can raise the risk of developing cancer of the esophagus.
Esophagitis, strictures, and Barrett's esophagus can happen if GERD is left untreated or if treatment is not effective.
If you have questions about your results, talk to your health care provider.
If you've been diagnosed with acid reflux or GERD, you may be able to reduce or eliminate your symptoms with diet and lifestyle changes. Diet changes include limiting:
- Fatty foods
- Spicy foods
- Citrus fruits and juices
- Tomatoes and tomato products
- Alcohol
Lifestyle changes include:
- Eating smaller amounts
- Quitting smoking
- Waiting a few hours after eating before you lie down
- Losing weight if needed
Over-the-counter medicines, such as antacids, may also be helpful.
If your symptoms don't improve or are more serious, your provider may recommend treatments to reduce or block acid production. These may include over-the-counter and/or prescription medications. Sometimes surgery is recommended for people with more severe and/or persistent symptoms.
1. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/diagnosis [accessed on Dec 17, 2018]
2. Esophageal pH monitoring: MedlinePlus Medical Encyclopedia [accessed on Dec 17, 2018]
3. 24-Hour Esophageal pH Study | Cedars-Sinai [accessed on Dec 17, 2018]
4. Esophageal 24-hour pH/Impedance Reflux Monitoring | Michigan Medicine [accessed on Dec 17, 2018]
5. 24-Hour Esophageal pH Test Information | Cleveland Clinic [accessed on Dec 17, 2018]
6. https://www.nature.com/gimo/contents/pt1/full/gimo31.html [accessed on Jul 27, 2021]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (2)

Barrett’s Esophagus Screening

Video by Lee Health/YouTube

Do You Have Acid Reflux or GERD?

Video by Cleveland Clinic/YouTube

1:43

Barrett’s Esophagus Screening

Lee Health/YouTube

2:51

Do You Have Acid Reflux or GERD?

Cleveland Clinic/YouTube

Barium Swallow Test

Barium Swallow Test

Also called: Esophagogram, Esophagram, Swallowing study

A barium swallow is an imaging test that checks for problems in the throat, esophagus, stomach, and part of the small intestine. The test involves drinking a chalky liquid that contains barium. Barium makes parts of the body show up more clearly on an x-ray.

Barium Swallow Test

Also called: Esophagogram, Esophagram, Swallowing study

A barium swallow is an imaging test that checks for problems in the throat, esophagus, stomach, and part of the small intestine. The test involves drinking a chalky liquid that contains barium. Barium makes parts of the body show up more clearly on an x-ray.

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Use the slider below to see how your results affect your health.
Your result is Normal.
A normal result shows that the esophagus, stomach, and small intestine are normal in size, shape, and movement.
Related conditions
A barium swallow is used to help diagnose conditions that affect the throat, esophagus, stomach, and first part the small intestine. These include:
- Ulcers
- Hiatal hernia, a condition in which part of your stomach pushes into the diaphragm. The diaphragm is the muscle between your stomach and chest.
- GERD (gastroesophageal reflux disease), a condition in which contents of the stomach leak backward into the esophagus
- Structural problems in the GI tract, such as polyps (abnormal growths) and diverticula (pouches in the intestinal wall)
- Tumors
You may need this test if you have symptoms of an upper GI disorder. These include:
- Trouble swallowing
- Abdominal pain
- Vomiting
- Bloating
A barium swallow is most often done by a radiologist or radiology technician. A radiologist is a doctor who specializes in using imaging tests to diagnose and treat diseases and injuries.
A barium swallow usually includes the following steps:
- You may need to remove your clothing. If so, you will be given a hospital gown.
- You will be given a lead shield or apron to wear over your pelvic area. This protects the area from unnecessary radiation.
- You will stand, sit, or lie down on an x-ray table. You may be asked to change positions during the test.
- You will swallow a drink that contains barium. The drink is thick and chalky. It's usually flavored with chocolate or strawberry to make it easier to swallow.
- While you swallow, the radiologist will watch images of the barium traveling down your throat to your upper GI tract.
- You may be asked to hold your breath at certain times.
- The images will be recorded so they can be reviewed at a later time.
A normal result means that no abnormalities in size, shape, and movement were found in your throat, esophagus, stomach, or first part of the small intestine.
If your results were not normal, it may mean you have one of the following conditions:
- Hiatal hernia
- Ulcers
- Tumors
- Polyps
- Diverticula, a condition in which small sacs form in the inner wall of the intestine
- Esophageal stricture, a narrowing of the esophagus that can make it hard to swallow
If you have questions about your results, talk to your health care provider.
1. https://www.niddk.nih.gov/health-information/diagnostic-tests/upper-gi-series [accessed on Sep 19, 2019]
2. https://medlineplus.gov/ency/article/003816.htm [accessed on Sep 19, 2019]
3. https://www.radiologyinfo.org/en/info.cfm?pg=uppergi [accessed on Sep 19, 2019]
4. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/upper-gastrointestinal-series [accessed on Sep 19, 2019]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (16)

Upper gastrointestinal series

Barium follow though showing the small bowel.

Image by Glitzy queen00 at en.wikipedia

Esophageal varices

Dilated and snake like varicose veins in esophagus of a patient with PHT. Upper gastrointestinal series.

Image by Nevit Dilmen (talk)

Esophageal varices

Dilated and snake like varicose veins in esophagus of a patient with PHT. Upper gastrointestinal series.

Image by Nevit Dilmen (talk)

Diffuse esophageal spasm

Upper gastrointestinal series. Corkscrew appearance of the esophagus due to Diffuse esophageal spasm. (DES) is a condition in which uncoordinated contractions of the esophagus occur.

Image by Nevit Dilmen (talk)

Zenker's diverticulum

Anatomy of Zenker's diverticulum

Image by Bernd Bragelmann Braegel. Mit freundlicher Genehmigung von Dr. Martin Steinhoff.

Zenker's diverticulum

Lateral X-ray of a Zenker's diverticula

Image by James Heilman, MD

Zenker's diverticulum

Xray showing a Zenker's diverticula (AP)

Image by James Heilman, MD

Upper GI Endoscopy Procedure in the ED

Video by Larry Mellick/YouTube

Preparing for an Upper GI Endoscopy - from the American Gastroenterological Association

Video by AmerGastroAssn/YouTube

Upper GI Bleed Causes- Overview

Video by Armando Hasudungan/YouTube

Barium Swallow- Esophageal Pathologies!

Video by How To Gastro/YouTube

Barium Upper GI Test | What To Expect!

Video by Amy/YouTube

Normal barium swallow fluoroscopic image, showing the ingested barium sulfate being induced down the oesophagus by peristalsis.

Normal barium swallow fluoroscopic image, showing the ingested barium sulfate being induced down the oesophagus by peristalsis.

Image by Bernd Brägelmann Braegel.

UpperGIEsophagealCAMark

Esophageal cancer as shown by a filling defect during an upper GI series

Image by James Heilman, MD

Upper gastrointestinal series

X-ray of the stomach with both positive (bariumsulphate) and negative (CO2)contrastmedia.

Image by Lucien Monfils

UGIs erosion

Multiple erosions in the antrum, shown in the upper GI series

Image by Med_Chaos

Upper gastrointestinal series

Glitzy queen00 at en.wikipedia

Esophageal varices

Nevit Dilmen (talk)

Esophageal varices

Nevit Dilmen (talk)

Diffuse esophageal spasm

Nevit Dilmen (talk)

Zenker's diverticulum

Bernd Bragelmann Braegel. Mit freundlicher Genehmigung von Dr. Martin Steinhoff.

Zenker's diverticulum

James Heilman, MD

Zenker's diverticulum

James Heilman, MD

5:02

Upper GI Endoscopy Procedure in the ED

Larry Mellick/YouTube

7:25

Preparing for an Upper GI Endoscopy - from the American Gastroenterological Association

AmerGastroAssn/YouTube

9:42

Upper GI Bleed Causes- Overview

Armando Hasudungan/YouTube

12:12

Barium Swallow- Esophageal Pathologies!

How To Gastro/YouTube

11:00

Barium Upper GI Test | What To Expect!

Amy/YouTube

Normal barium swallow fluoroscopic image, showing the ingested barium sulfate being induced down the oesophagus by peristalsis.

Bernd Brägelmann Braegel.

UpperGIEsophagealCAMark

James Heilman, MD

Upper gastrointestinal series

Lucien Monfils

UGIs erosion

Med_Chaos

Treatment

Antacids

Image by Brett_Hondow

Antacids

Antacids

Image by Brett_Hondow

How Do Doctors Treat GER and GERD in Children?

Doctors may recommend lifestyle changes or medicines to treat gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD) in children. In some cases, doctors may also recommend surgery.

Lifestyle changes

Doctors may recommend lifestyle changes to reduce GER or GERD symptoms. Research suggests that certain lifestyle changes improve GERD symptoms in adults, but studies in children are limited.

Lifestyle changes your child’s doctor recommends may depend on your child’s age and symptoms. For example, doctors may recommend that children who have GERD

sleep with their head elevated or sleep on their left side
avoid eating just before they lie down or go to bed
change their eating habits or diet
avoid secondhand smoke or, if they smoke, quit smoking

Medicines

If lifestyle changes don’t relieve your child’s GERD symptoms, your child’s doctor may prescribe medicines. Some GERD medicines are available over the counter. Don’t use over-the-counter or prescription medicines to treat your child’s GERD unless told to do so by your child’s doctor.

Proton pump inhibitors (PPIs). PPIs lower the amount of acid the stomach makes. PPIs are better at treating GERD symptoms and healing the esophageal lining than other medicines, such as H2 blockers. Doctors typically prescribe PPIs to treat GERD in children for 4 to 8 weeks. In some cases, doctors may prescribe PPIs for long-term treatment.

PPIs are generally safe and effective. Side effects of PPIs may include diarrhea, headache, or upset stomach. PPIs may increase the chance of getting certain types of infections. Experts are still studying the effects of taking PPIs for a long time or in high doses. Talk with your child’s doctor about the risks and benefits of PPIs.

H2 blockers. H2 blockers lower the amount of acid the stomach makes. H2 blockers can help heal the esophagus, but not as well as PPIs can. H2 blockers may cause side effects, such as abdominal pain, diarrhea, and headache, and may increase the chance of getting certain types of infections.

Antacids. In some cases, doctors may recommend short-term use of antacids to relieve mild GER and GERD symptoms in older children or teens. These medicines can have side effects, such as diarrhea or constipation. Doctors don’t recommend long-term use of antacids, which may lead to serious health problems.

Other medicines. If PPIs, H2 blockers, and antacids don’t improve a child’s symptoms, the doctor may recommend other medicines.

Surgery

Doctors may recommend surgery to treat GERD in children if medicines and lifestyle changes don’t improve symptoms or if serious GERD complications occur. Children are more likely to develop complications from surgery than from medicines.

Fundoplication is the most common surgery for GERD. In most cases, it leads to long-term improvement of GERD symptoms. Surgeons most often perform fundoplication as laparoscopic surgery, making small cuts in the abdomen and inserting special tools to perform the operation. Laparoscopic fundoplication leaves several small scars. During the procedure, surgeons sew the top of the stomach around the end of the esophagus, which adds pressure to the lower esophageal sphincter and helps reduce reflux.

Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Additional Materials (3)

How to Treat Acid Reflux in Toddlers- Pregnancy & Parenting- ModernMom

Video by ModernMom/YouTube

When a Child or Teen Has Gastroesophageal Reflux Disease (GERD) - Dr. Mitchell Katz

Video by CHOC Children's/YouTube

5. How do you treat children with reflux?

Video by childrenshospgh/YouTube

3:45

How to Treat Acid Reflux in Toddlers- Pregnancy & Parenting- ModernMom

ModernMom/YouTube

2:11

When a Child or Teen Has Gastroesophageal Reflux Disease (GERD) - Dr. Mitchell Katz

CHOC Children's/YouTube

0:33

5. How do you treat children with reflux?

childrenshospgh/YouTube

Eating, Diet, & Nutrition

Child face plating into a cake

Image by Henley Design Studio

Child face plating into a cake

Child eating cake

Image by Henley Design Studio

Eating, Diet, & Nutrition for GER & GERD in Children

How can changes in eating habits improve GER or GERD symptoms in children?

For children who have gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD) symptoms at night or while lying down, doctors may suggest they avoid eating for a few hours before they lie down or go to bed.

Being overweight or having obesity can increase the chance that a child will have GER or GERD. If you are concerned about your child's weight, talk with your child’s doctor. The doctor can check your child's overall health and growth and tell you if weight management may be helpful. Don't put your child on a weight-loss diet unless your child’s doctor tells you to.

What should a child with GERD avoid eating or drinking?

Some children who have GERD find that certain foods or drinks trigger symptoms or make symptoms worse. You or your child should talk with your child’s doctor about any foods or drinks that seem to increase GERD symptoms. The doctor may recommend reducing or avoiding certain foods or drinks to see if symptoms improve.

Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Additional Materials (3)

Kids get acid reflux too

Video by WXYZ-TV Detroit | Channel 7/YouTube

Fit Food

You want your child to be fit and healthy for a whole lifetime. That’s why it’s so important for you to start helping him or her to develop healthy eating habits now. Changing habits is easier when you’re young. What’s more, tackling overweight early on can prevent many or all of the devastating medical effects of obesity.

Image by TheVisualMD

Fit Food

You want your child to be fit and healthy for a whole lifetime. That’s why it’s so important for you to start helping him or her to develop healthy eating habits now. Changing habits is easier when you’re young. What’s more, tackling overweight early on can prevent many or all of the devastating medical effects of obesity.

Image by TheVisualMD

2:34

Kids get acid reflux too

WXYZ-TV Detroit | Channel 7/YouTube

Fit Food

TheVisualMD

Fit Food

TheVisualMD

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Acid Reflux (GER & GERD) in Children

Children can get gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD), which happen when stomach contents leak back up into their esophagus. Learn the difference between GER and GERD, and about common symptoms and treatments.

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