Diagnosis of GER & GERD in Children & Teens

How do doctors diagnose GER in children and teens?

In most cases, a doctor diagnoses gastroesophageal reflux (GER) by reviewing a child or teen’s symptoms and medical history. If symptoms of GER do not improve with lifestyle changes and anti-reflux medicines, he or she may need testing.

How do doctors diagnose GERD in children and teens?

If a child or teen’s GER symptoms do not improve, if they come back frequently, or he or she has trouble swallowing, the doctor may recommend testing for gastroesophageal reflux disease (GERD).

The doctor may refer the child or teen to a pediatric gastroenterologist to diagnose and treat GERD.

What tests do doctors use to diagnose GERD?

Several tests can help a doctor diagnose GERD. A doctor may order more than one test to make a diagnosis.

Upper GI Series

An upper GI series looks at the shape of the child or teen’s upper GI tract.

During the procedure, the child or teen will drink liquid contrast (barium or gastrograffin) to coat the lining of the upper GI tract. The x-ray technician takes several x-rays as the contrast moves through the GI tract. The technician or radiologist will often change the position of the child or teen to get the best view of the GI tract. They may press on the child’s abdomen during the x-ray procedure.

The upper GI series can’t show mild irritation in the esophagus. It can find problems related to GERD, such as esophageal strictures, or problems with the anatomy that may cause symptoms of GERD.

Children or teens may have bloating and nausea for a short time after the procedure. For several days afterward, they may have white or light-colored stools from the barium. A health care professional will give you specific instructions about the child or teen’s eating and drinking after the procedure.

Esophageal pH and impedance monitoring

The most accurate procedure to detect acid reflux is esophageal pH and impedance monitoring. Esophageal pH and impedance monitoring measures the amount of acid or liquid in a child or teen’s esophagus while he or she does normal things, such as eating and sleeping.

This procedure takes place at a hospital or outpatient center. A nurse or physician places a thin flexible tube through the child or teen’s nose into the stomach. The tube is then pulled back into the esophagus and taped to the child or teen’s cheek. The end of the tube in the esophagus measures when and how much acid comes up into the esophagus. The other end of the tube attaches to a monitor outside his or her body that records the measurements. The placement of the tube is sometimes done while a child is sedated after an upper endoscopy, but can be done while a child is fully awake.

The child or teen will wear a monitor for the next 24 hours. He or she will return to the hospital or outpatient center to have the tube removed. Children may need to stay in the hospital for the esophageal pH and impedancemonitoring.

This procedure is most useful to the doctor if you keep a diary of when, what, and how much food the child or teen eats and his or her GERD symptoms after eating. The gastroenterologist can see how the symptoms, certain foods, and certain times of day relate to one another. The procedure can also help show whether acid reflux triggers any respiratory symptoms the child or teen might have.

Upper Gastro Intestinal (GI) endoscopy and biopsy

In an upper GI endoscopy, a gastroenterologist, surgeon, or other trained health care professional uses an endoscope to see inside a child or teen’s upper GI tract. This procedure takes place at a hospital or an outpatient center.

An intravenous (IV) needle will be placed in the child or teen’s arm to give him or her medicines that keep him or her relaxed and comfortable during the procedure. They may be given a liquid anesthetic to gargle or spray anesthetic on the back of his or her throat. The doctor carefully feeds the endoscope down the child or teen’s esophagus then into the stomach and duodenum. A small camera mounted on the endoscope sends a video image to a monitor, allowing close examination of the lining of the upper GI tract. The endoscope pumps air into the child or teen’s stomach and duodenum, making them easier to see.

The doctor may perform a biopsy with the endoscope by taking small pieces of tissue from the lining of the child or teen’s esophagus, stomach, or duodenum. He or she won’t feel the biopsy. A pathologist examines the tissue in a lab.

In most cases, the procedure only diagnoses GERD if the child or teen has moderate to severe symptoms.

April 2015

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.