Is Reflux "Functional"?
Last time, I discussed the communication problems that might arise when a baby has worrisome digestive symptoms such as Gastroesophageal Reflux. The baby, the parent (often the mother) and the doctor may see things from different points of view resulting in a breakdown of communication. After evaluating the baby, the doctor may tell the mother that the baby is “healthy” and the tests were “normal”. The doctor has ruled out more serious conditions such as Gastroesophageal Reflux Disease (GERD) but the message often gets interpreted by the mother/parent in a different way. She may be thinking, “There is something wrong and the doctor doesn’t understand.” Maybe the parent and the doctor need to have a different conversation about Gastroesophageal Reflux (GER), what it is and how to cope with it.
Recently, I attended a GI conference and heard a great deal of discussion about “Functional” GI disorders. It was surprising to hear that infant Gastroesophageal Reflux and Infant Colic were considered Functional GI Disorders. So what is so functional about infant reflux? It really seems more dysfunctional than functional doesn’t it? Maybe there is a breakdown in communication about infant reflux and colic specifically when we are talking about the causes and treatments of these conditions.
In medicine, there is a distinction between organic illness and functional illness.
Organic Illness Functional Illness
An illness or condition that A condition that has no consistent
causes a change to the tissue, biological markers.
organs and cells of the body.
Examples: Esophagitis Examples: Gastroesophageal Reflux
Eosinophilic Esophagitis (Infant regurgitation), Infant Colic
Test: blood test, x-ray, etc Test: No test available.
Diagnosis: Abnormal test Diagnosis: None. Test results will be
Treatment: Treatment will Treatment: Treatment is supportive and
begin based on symptoms and may include positioning, smaller feedings,
test results. May include medi- short term treatment with medication or
cation and changes to the diet. dietary changes.
Outcome: Symptoms will Outcome: In the case of colic and GER,
improve over time. Symptoms will gradually decrease as the baby outgrows colic and infant reflux.
For further information on this topic, check out the Rome Criteria website.
Now back to the baby, the parent and the doctor. The doctor needs to explain colic and infant reflux in a new way, distinguishing between a functional condition (infant reflux and colic) and an organic disease (Gastroesophageal Reflux Disease). The symptoms of a functional condition and an organic disease are real and cause real symptoms. If you have a splitting headache, you most likely have a functional disorder. There is no blood test or x-ray to show that you have a headache. It sure hurts. You sure need treatment for it. If you went to the doctor, the doctor would evaluate your headache symptoms and determine if you have an organic headache or a functional headache. The tests and treatments would reflect the doctor’s judgement on the cause of the headache. Hopefully the treatments would reduce or eliminate the symptoms. Often when we go to the doctor, we expect a prescription and a cure. What if the doctor said the headaches were caused by dehydration and you needed to drink more water? You might be disappointed that you didn’t get a better treatment plan.
It is the same with infant reflux and colic. Your baby is uncomfortable and crying. She certainly needs assistance to feel better but she does not have an organic disease such as GERD or esophagitis. Maybe she doesn’t need medication after all. Or the doctor prescribed medication and it didn’t reduce the crying and discomfort at all. Doctors get frustrated when parent request GERD medication for a functional condition such as GER or colic. Unfortunately, doctors do not always have the time to teach the tools parents need to cope with infant reflux at home and offer the support and treatments that work to reduce symptoms. In desperation, the family seeks other methods of trying to reduce the symptoms, often without the help of the doctor.
I wish parents and doctors had a bigger toolbox of techniques and treatments for reducing the crying and discomfort associated with infant reflux and colic. Swaddling, holding, wearing your baby, positioning, diet and formula changes and probiotics have all shown promise in at least helping some babies with reflux and colic feel better.