Acid Reflux (GERD) In Teens Symptoms, Treatment, And Remedies

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Acid reflux, also known as acid indigestion or gastroesophageal reflux (GER), is common among children and teens between two and 19 years (1). It occurs when the contents of the stomach come back up into the esophagus. The stomach acid that touches the lining of the esophagus might cause heartburn. Although everyone experiences acid reflux occasionally, when it happens quite frequently, it may cause severe health problems over time.

The more severe and long-lasting form of GER is called gastroesophageal reflux disease (GERD). If your teen experiences GER more than twice a week for a few weeks, it could be GERD (1) (2). Read this post to know about acid reflux in teens, its symptoms, treatment options, and when you should take your teen to the doctor.

Is It Normal For A Teenager To Have Acid Reflux?

GER is commonly observed in children and teens. However, it doesn’t mean they have GERD. Although around 25% of teens experience GERD symptoms, it is more common in adults (1).

Signs And Symptoms Of Acid Reflux In Teens

The signs and symptoms of GERD in children and teens may vary depending on age. The commons symptoms of GERD include (1) (3) (4):

  • Heartburn: Children with GERD who are younger than 12 years may not experience heartburn. On the other hand, children who are 12 or older may experience heartburn regularly due to acid reflux. Heartburn is described as a feeling of burning and pain in the middle of the abdomen, central part of the chest, and behind the breastbone.
  • Bad or foul breath
  • Nausea
  • Frequent regurgitation
  • Vomiting
  • Hoarseness
  • Difficulty in swallowing
  • Pain while swallowing
  • Dental erosion or wearing away of teeth
  • Breathing problems: Teens with GERD may breathe stomach acid into their lungs, resulting in irritation in the throat and lungs. These respiratory problems may include persistent cough, sore throat, chest congestion, wheezing, or recurrent pneumonia.

Causes Of Acid Reflux In Teens

Gastroesophageal reflux disease occurs when the lower esophageal sphincter — the muscle that separates the esophagus from the stomach — becomes weak or relaxes abnormally, resulting in the rise of the stomach contents (stomach acid) into the esophagus. This muscle may become weak or abnormally relaxed due to the following reasons (3) (4).

  • Excess pressure on the abdomen from being overweight, obese, or pregnant
  • Certain painkillers, antidepressants (used in the treatment of depression), and sedatives (used to induce sleep)
  • Medications used to treat asthma
  • Antihistamines (used to treat the symptoms of allergies)
  • Smoking or secondhand smoke
  • Certain health conditions, such as cerebral palsy
  • Severe developmental delay
  • Previous surgery on the abdomen or esophagus
  • Hiatal hernia — a condition wherein the upper part of the stomach bulges upward into the chest through the diaphragm

Risks And Complications Of Acid Reflux In Teens

If your teen doesn’t receive appropriate treatment, GERD may lead to the following health complications (1).

  • Esophagitis: It is the inflammation or irritation of the esophagus. It may lead to the formation of ulcers in the lining of the esophagus.
  • Esophageal stricture: This problem occurs when the esophagus becomes too narrow, leading to difficulty in swallowing.
  • Respiratory problems: The stomach acid can irritate the lungs and the throat and cause other health problems, including asthma, chest congestion (due to extra fluid in the lungs), sore throat, persistent dry cough, hoarseness (partial loss of voice), aspiration pneumonia, laryngitis (inflammation of the voice-box that may cause temporary voice loss), and wheezing (a high-pitched sound while breathing).

When To See A Doctor?

Consult a doctor if your teen experiences the following (3):

  • Severe vomiting
  • Frequent projectile or forceful vomiting
  • Breathing problem after vomiting
  • Presence of blood in the vomit
  • Presence of green or yellow fluid in the vomit
  • Presence of fluid that appears like ground coffee in the vomit
  • Pain in the throat or mouth while eating
  • Pain while swallowing or difficulty in swallowing
  • Loss of appetite
  • Weight loss or poor growth
  • Signs of dehydration

Diagnosis Of Acid Reflux In Teens

If the symptoms of acid reflux in your teen appear frequently, and there’s no improvement after changes in the diet or lifestyle, or if your teen has difficulty swallowing, consult a pediatric gastroenterologist for appropriate diagnosis and treatment. The doctor may run a few tests to diagnose GERD.

During the visit, the doctor will first conduct a physical examination to understand your child’s symptoms and medical history. If the diagnosis is not conclusive, the doctor might suggest one or more of the following tests to examine the esophagus, stomach, and small intestines (2) (4) (5) (6).

  • Upper GI series: This test is done to check the shape of your teen’s upper gastrointestinal (GI) tract. Your child will need to drink a liquid called barium, which provides contrast during X-ray imaging. The radiologist will take multiple X-rays as barium flows through the esophagus to the stomach. After the procedure, the child may experience nausea, bloating, or light stools. Your doctor will guide you through the specific instructions for the procedure.
  • Upper GI endoscopy: This procedure is carried out by a gastroenterologist or a trained healthcare professional. A long, flexible tube fitted with a camera lens at its end is used to examine the digestive tract, including the esophagus, stomach, and duodenum (initial part of the small intestine).
  • Upper GI biopsy: During the endoscopy procedure, the doctor may also perform a biopsy, which involves taking a small piece of the tissue from the lining of the esophagus, stomach, or duodenum for pathological examination.
  • Esophageal pH and impedance monitoring: It is the most accurate diagnostic test to detect acid reflux in teens. In this procedure, a thin, flexible tube is placed inside the stomach through the nose. This tube is then pulled back into the esophagus and attached to the cheek. The monitoring device measures the amount of acid or liquid in your child’s esophagus as they sleep, eat, or do regular activities. This test may require a hospital stay.

Treatment For Acid Reflux

The treatment for acid reflux may vary depending on the symptoms and severity of the condition. The doctor may suggest lifestyle changes, medications, or surgery (4) (6).

1. Lifestyle changes to control GER or GERD in teens may include:

  • Consuming smaller and frequent meals
  • Losing weight, if obese
  • Avoiding fatty, spicy, or greasy foods and drinks
  • Avoiding overeating and late-night snacks (no food two to three hours before sleeping)
  • Avoiding lying down straight after a meal
  • Quitting smoking and avoiding secondhand smoke
  • Avoiding processed and fast foods
  • Wearing loose clothes around the stomach
  • Sleeping at a slight angle — raising the head of the bed by six to eight inches by putting solid support (pillows may not work)

2. Medications (prescription and over-the-counter (OTC)) may be prescribed if the symptoms do not improve. Your teen may need a combination of medicines to alleviate the symptoms. Always consult your doctor before administering any medications to your child.

  • Antacids: The doctor may prescribe the following antacids to counter the effects of GERD:

i. Alka-Seltzer
ii. Maalox
iii. Mylanta
iv. Rolaids

These antacids may cause side effects, including diarrhea and constipation.

  • H2 blockers: They are used to block or decrease the acid production in the stomach. These medications may provide short-term relief.

i. Cimetidine (Tagamet HB)
ii. Famotidine (Pepcid AC)
iii. Nizatidine (Axid AR)
iv. Ranitidine (Zantac 75)

Sometimes, a combination of antacids and H2 blockers are recommended if teens experience heartburn after a meal. Antacids neutralize the acid, and H2 blockers decrease the production of acid.

  • Proton pump inhibitors (PPIs): Like H2 blockers, PPIs decrease the amount of acid produced by the stomach. Doctors prescribe PPIs for long-term GERD treatment. PPIs work better at treating GERD symptoms than H2 blockers as they effectively heal the esophagus lining. The doctor may prescribe the following PPIs.

i. Esomeprazole (Nexium)
ii. Iansoprazole (Prevacid)
iii. Omeprazole (Prilosec, Zegerid)
iv. Pantoprazole (Protonix)
v. Rabeprazole (AcipHex)

  • Prokinetics: Prokinetics help in faster clearing of the stomach. Prescription prokinetics include

i. Bethanechol (Urecholine)
ii. Metoclopramide (Reglan)

Both of these medicines may cause side effects, including nausea, fatigue, diarrhea, anxiety, and depression. Prokinetics are not recommended with other medicines as combinations may cause problems.

  • Antibiotics: Antibiotics, such as erythromycin, may also help empty the stomach and may not have as many side effects as prokinetics. However, it may cause  diarrhea.

3. Surgery could be considered as the last option if symptoms persist even after lifestyle changes and medication. Fundoplication is the most common surgical procedure for the treatment of GERD.

Home Remedies For Acid Reflux In Teens

The following home remedies may also help treat acid reflux symptoms (7, 8, 9).

  1. Baking soda: Being a base, it may help neutralize acid production in the stomach. Take a teaspoon of baking soda with eight ounces of water. Excess baking soda can cause vomiting or nausea.
  1. Fruits: Bananas have natural antacid properties that reduce acid reflux. Having bananas daily can decrease discomfort. Even apples help ease acid indigestion and can be consumed before going to bed. Moreover, fruits such as honeydew, cantaloupe, and watermelon can prove helpful. However, try to avoid acidic fruits, such as oranges, pineapple, and grapefruit.
  1. Ginger tea: Ginger tea is a great remedy for various stomach ailments, such as frequent stomach pain, nausea, and acid indigestion. Boil slices of ginger roots in water for around 30 minutes to enjoy its health benefits.
  1. Healthy foods: Home-cooked and freshly-prepared foods must be consumed daily. Avoid caffeine, carbonated drinks, alcohol, and chocolates. Make sure to drink plenty of fluids.
  1. Chewing gum: It is said that chewing sugar-free gum may also help ease reflux symptoms.
  1. Chamomile tea: Chamomile tea has been said to offer relief in heartburn. Simmer chamomile petals in water for around 30 minutes and drink a cup with honey before bedtime to ease the symptoms.
  1. Aloe vera juice: Aloe vera juice or pulp may also help reduce heartburn.
  1. Apple cider vinegar: This remedy may work for some but not for others. A teaspoon of unprocessed apple cider vinegar with water can help balance stomach acidity.

Gastroesophageal reflux disease is a digestive disorder that can lead to serious health complications in teens if untreated. The symptoms of GERD may vary among children depending on age. However, lifestyle and dietary changes alone or in combination with medications can help control the symptoms. If your teen experiences any recurrent symptoms, make sure to consult a doctor before trying OTC medications or home remedies.

References:

1. Definition & Facts for GER & GERD in Children & Teens: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
2. Symptoms and Diagnosis of GERD in Teens: GI Kids. North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN)
3. Symptoms & Causes of GER & GERD in Children & Teens: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
4. Reflux in Children: Medline Plus, U.S. National Library of Medicine
5. Diagnosis of GER & GERD in Children & Teens: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
6. Treatment of GER & GERD in Children & Teens: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
7. 7 Natural GERD Home Remedy Solutions: Fisher-Titus
8. Gastroesophageal Reflux Disease—Adolescent: Winchester Hospital
9. Home Remedies For Heartburn (And When You Need A Doctor): Franciscan Health

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