Dr. Eisner Answers Your GERD Questions

My newborn baby has been spitting up and vomiting a lot after feeding. Is this a sign of reflux, and what can be done?

Symptoms of gastroesophageal reflux disease in an infant may include burping, frequent spitting up or non-projectile vomiting, frequent night waking, poor weight gain, difficulty swallowing and sudden, inconsolable crying. Unless the infant shows signs of poor growth, severe choking, or lung disease, it is rarely necessary to perform a work-up until the child is over 1 years of age. One thing that can be done is to consider breast-feeding. There are a few ways that breast-feeding decreases the likelihood of reflux.

First, the baby's tongue triggers peristaltic waves along the gastrointestinal tract. These contractions help to move the food down into the stomach and on to the small intestine. Secondly, human milk digests more completely than and almost twice as fast as formula. The less time the milk spends in the stomach, the less chance that there is for it to reflux into the esophagus. Finally, since breastfed babies are generally fed in a more upright position, gravity may help to keep the milk and gastric acid in the stomach, thereby decreasing the chance for reflux.

If the symptoms persist, your doctor might want to perform some tests. While rarely needed, they may include: barium swallow x- ray exams, endoscopy with biopsy, pH probe, and other invasive techniques. You should discuss these issues with your baby's doctor, but keep in mind, that tests can be dangerous and are typically inconclusive.

I have suffered from reflux for years, but lately I have been having difficulty swallowing food. My insurance company will not allow me to have an endoscopy as I had one last year. My examination last revealed Barrett's esophagus with no dysplasia. What can be done?

Difficulty swallowing is a concern in patients with longstanding reflux disease. While typically patients with Barrett's esophagus without dysplasia can wait 2-3 years to undergo another endoscopy, when difficulty swallowing develops, endoscopy must be performed to rule out esophageal cancer. You and your physician must appeal to your insurance company to have the procedure authorized. Given that your Barretts was at a low grade last year, hopefully at worst you will have a benign peptic stricture as the cause of your swallowing problem. If that is the case, your doctor can dilate your esophagus with either a balloon or Maloney dilator during the endoscopy.

I have been having a lot of hiccups lately. I read that this can occur with reflux. Is this true?

Hiccups occur as a result of sudden involuntary contractions of the diaphragm. The most common causes of hiccups are swallowing air, usually from eating too fast, chewing gum, or drinking carbonated beverages. Hiccups also can occur in response to alcohol or spicy foods. Stress and excitement can lead to reflux as well. Acid reflux can result in an increased incidence of hiccups.