GER vs. GERD- What’s the Difference?
Questions and concerns about infant spitting up or regurgitation are very common. Indeed, 2/3 of infants spit up or regurgitate at some point and parents raise concern about this in 1/4 of all well baby visits. GER (Gastroesophageal Reflux) is felt to be a benign process if occasional, even frequent, regurgitation is not associated with other symptoms and proper weight gain. This is in contrast to GERD (disease) where infants either have troublesome symptoms or complications of GER. With the increased use of prescribed antacid medications, specialists are trying to better differentiate GER from GERD so that infants are properly treated.
To review, spitting up or regurgitating is considered a normal process in babies and, of course, can continue to occur as we get older. Research has found that nearly half of 4 month olds have some reflux but it’s largely outgrown by age one. Symptoms of GERD that should raise concern are a history of vomiting associated with irritability, poor or difficult feedings, apparent painful swallowing or frequent repositioning during feeds or afterwards (arching of the back). Poor weight gain is another risk factor.
For most patients, a good history and physical can help differentiate GER from GERD. Interestingly, X-ray evaluation (upper GIs); have not been shown to help differentiate either the extent or severity of GER. There are more conclusive tests for GER but they are more invasive and usually require hospitalization.
For management, specialists emphasize “life style” changes as the first line treatment. These include proper feeding, holding and burping techniques and avoiding over feeding. Thickened feeds (usually with rice cereal) have been shown to improve reflux. There are now commercial formulas that may help. They are thickened but otherwise nutritionally and calorically balanced. The use of medications remains controversial but is really necessary only for infants with GERD. Complications of acid reflux are uncommon in this age group. The aim is to manage and minimize symptoms until the large majority of infants outgrow the condition.