SPITTING UP – REFLUX

TYPES

When it comes to spitting up and reflux, there are two main types: physiological reflux and pathological reflux.

1. Physiological reflux: This type of reflux is considered normal and occurs in most infants. It happens due to an immature digestive system and typically resolves on its own as the baby grows. Physiological reflux is characterized by occasional spitting up, usually after feeding, without causing significant discomfort or interfering with normal growth and development. It is not associated with complications or other underlying medical conditions.

2. Pathological reflux: Also known as gastroesophageal reflux disease (GERD), this type of reflux is more severe and requires medical attention. Pathological reflux occurs when the lower esophageal sphincter (LES) weakens or malfunctions, allowing stomach acid to flow back into the esophagus on a regular basis. This can lead to various symptoms and complications, such as discomfort, pain, poor weight gain, esophagitis (inflammation of the esophagus), and respiratory problems. Pathological reflux requires diagnosis and treatment by a healthcare professional.

SYMPTOMS

Spitting up and reflux can present various symptoms, depending on the individual and the severity of the condition. Here are some common symptoms associated with reflux:

1. Spitting up: The most noticeable symptom is the regurgitation or spitting up of stomach contents, which may occur after feeding or at other times. The spitting up is usually effortless and can range from small amounts to larger volumes.

2. Irritability and crying: Reflux can cause discomfort and irritability in infants, leading to excessive crying, especially during or after feeding. Adults may also experience increased irritability, especially if reflux symptoms are persistent.

3. Arching of the back: Infants with reflux may arch their backs in response to the discomfort caused by stomach acid flowing into the esophagus. This can be a sign of discomfort or pain.

4. Poor weight gain: In some cases, infants with reflux may have difficulty gaining weight due to frequent spitting up and inadequate intake of nutrients. It is important to monitor an infant’s weight gain and consult with a healthcare professional if there are concerns.

5. Refusal to feed: Infants may display signs of refusal to feed or exhibit feeding difficulties due to the discomfort associated with reflux. They may pull away from the breast or bottle or show signs of distress during feeding.

6. Heartburn and regurgitation: In adults with reflux or GERD, symptoms can include heartburn, which is a burning sensation in the chest, and regurgitation, where stomach acid rises up into the throat or mouth. These symptoms can be accompanied by a sour or bitter taste in the mouth.

7. Difficulty swallowing: Some individuals with reflux may experience difficulty swallowing, known as dysphagia, which can be accompanied by a sensation of food getting stuck in the throat.

DIAGNOSIS

Diagnosing spitting up and reflux typically involves a combination of medical history, physical examination, and sometimes additional tests. Here are some common methods used for diagnosis:

1. Medical history: A healthcare professional will review the patient’s medical history, including symptoms, frequency of spitting up, feeding patterns, and any other relevant information. They may also ask about the presence of other symptoms such as poor weight gain, irritability, or difficulty swallowing.

2. Physical examination: The healthcare professional will perform a physical examination to assess the overall health of the individual. They may pay particular attention to the abdomen, checking for any signs of discomfort, tenderness, or abnormality.

3. Symptom monitoring: Keeping a diary of spitting up episodes, including the timing, frequency, and associated symptoms, can be helpful in diagnosing reflux. This information can provide valuable insights into the patterns and severity of the condition.

4. Trial of interventions: In some cases, a healthcare professional may suggest trying certain interventions, such as changes in feeding techniques or positioning, to see if they alleviate the symptoms. If there is improvement with these interventions, it can help confirm a diagnosis of reflux.

5. Additional tests: In certain situations where the diagnosis is unclear or if there are concerns about complications, further tests may be recommended. These can include:

– Upper gastrointestinal (GI) series or barium swallow: This test involves the individual swallowing a contrast dye, which helps visualize the structure and function of the esophagus and stomach on X-rays.

– pH monitoring: A small probe is inserted through the nose and into the esophagus to measure the amount of acid present over a 24-hour period. This test can help determine the frequency and severity of reflux episodes.

– Endoscopy: A flexible tube with a camera is inserted through the mouth to examine the lining of the esophagus and stomach. This procedure allows for direct visualization of any inflammation or damage caused by reflux.

– Esophageal impedance testing: This test measures the movement of liquid and gas in the esophagus and can help determine if non-acidic contents are causing symptoms.

TREATMENT

The treatment for spitting up and reflux depends on the severity of the symptoms and the age of the individual. Here are some common approaches to managing and treating reflux:

1. Lifestyle and feeding modifications: Making changes to feeding techniques and lifestyle can often help reduce reflux symptoms. These may include:

– Frequent, smaller feedings: Offering smaller, more frequent feedings can help prevent overfeeding and reduce the likelihood of spitting up.

– Burping: Burping the baby during and after feedings can help release any trapped air and reduce the chances of reflux.

– Upright positioning: Keeping the baby in an upright position for at least 30 minutes after feeding can help gravity keep the contents of the stomach down.

– Avoiding overfeeding: Ensuring that feeding sessions are paced appropriately and not rushing through them can help prevent overfilling of the stomach.

– Thickening feeds: For infants, adding a small amount of rice cereal to breast milk or formula can help thicken the feeds, making them less likely to be regurgitated.

2. Medications: In certain cases, healthcare professionals may recommend medications to help manage reflux symptoms. These may include:

– Antacids: Over-the-counter antacids can help neutralize stomach acid and provide relief from heartburn and acid reflux symptoms.

– H2 blockers: These medications can reduce the production of stomach acid and provide longer-lasting relief from reflux symptoms.

– Proton pump inhibitors (PPIs): PPIs are stronger medications that also reduce stomach acid production and may be prescribed for more severe cases of reflux.

3. Positioning: Adjusting the positioning of individuals during sleep can help reduce reflux symptoms. Elevating the head of the bed or using a wedge-shaped pillow can help prevent stomach acid from flowing back into the esophagus.

4. Dietary changes: For older children and adults, avoiding certain trigger foods and beverages, such as caffeine, spicy foods, citrus fruits, and fatty or fried foods, may help reduce reflux symptoms. It is advisable to consult with a healthcare professional or registered dietitian for personalized dietary recommendations.

5. Surgery: In rare cases where reflux symptoms are severe and not responding to other treatment options, surgery may be considered. Surgical procedures can help reinforce the lower esophageal sphincter or repair any anatomical abnormalities that contribute to reflux.