By Karin Klein
Heartburn is not just an adult problem. In fact, 1 in 4 teenagers has gastroesophageal reflux disease (GERD), a serious disorder that damages the body and can lead to cancer. Here’s what you need to know about this childhood health threat... Since age 6, Kyla Barrett, now 13, would wake up in the middle of the night with a severe burning pain in her stomach and chest. After about 10 minutes, she’d throw up a bit, and then was left with burning pain in her throat.
The pain was so bad that Kyla had to be home-schooled for fifth grade, an experience she found isolating.
A doctor recommended surgery to lengthen Kyla’s abnormally short esophagus, but the surgeon cast doubt on that treatment, says Kyla’s mother, Julia Barrett.
And now the Tehachapi, California, family is very glad they skipped that surgery — although it took many years to get to the bottom of Kyla’s painful gastrointestinal problems.
Kyla had the classic symptoms of gastroesophageal reflux disease (GERD) – a disease more common in adults than kids.
GERD can occur in all age groups, but it’s growing fastest in children and teens. Up to 25% of teenagers have GERD symptoms, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Why Teens Are Getting GERD
More teens are overweight, making GERD more likely, explains Ketan Shah, MD, who practices gastroenterology, internal medicine and pediatrics at Saddleback Medical Center in Laguna Hills, California.
“Children and adolescents are increasingly developing conditions previously seen only in adults,” he says. “This is especially true in Western countries – likely because of our poor dietary habits and inadequate physical activity, which lead to increased rates of obesity.”
Teens’ fondness for junk food – French fries, pizza and burgers – also may play a role, adds Bhavesh B. Shah, MD (no relation to Dr. Ketan Shah), medical director of interventional gastroenterology at Long Beach Medical Center in Long Beach, California.
“Fast foods, which have high fat content and may be deep-fried, are exactly the types of foods known to trigger GERD,” he says.
How GERD Occurs
It starts with the sphincter, a band of muscles between the esophagus and stomach. Normally, the sphincter operates as a one-way valve, allowing food to go down into the stomach while preventing it, along with acid, from backing up into the esophagus.
In GERD patients, however, the valve doesn’t work properly. It either begins to relax occasionally or stays permanently loose, allowing stomach contents back up in the esophagus, Dr. Ketan Shah explains.
That happens for a couple of reasons:
- Obesity or overeating places pressure on the valve and weakens it.
- Consuming certain substances – including spicy foods, caffeine, peppermint, chocolate or alcohol – and smoking can cause the sphincter to relax abnormally.
Why GERD Is Dangerous
In the short run, GERD causes heartburn and upper abdominal pain, and may lead to food getting stuck in the throat or discomfort when swallowing.
If stomach acid reaches the throat, patients may experience laryngitis, a sore throat or jaw, and ear pain. It may also cause respiratory problems, including pneumonia and asthma, which stem from breathing stomach acid into the lungs, according to the NIDDK.
If GERD continues for years without treatment, it turns dangerous. It may cause inflammation, ulcers or permanent narrowing in the esophagus, Dr. Ketan Shah warns.
It may also lead to Barrett’s esophagus, the precursor to potentially deadly esophageal cancer.
Teens Face Higher Risks
Will decades of reflux among young people create a generation of adults with a high risk of esophageal cancer?
Dr. Ketan Shah believes so: “Studies have shown that having GERD for an increased duration, or starting at a younger age, are risk factors for Barrett’s esophagus and esophageal cancer.”
He and his colleagues found a direct link between pediatric GERD and future development of Barrett’s esophagus and esophageal cancer in a study they published in the journal Gastroenterology in 2015.
“We found the risk of developing Barrett’s esophagus or esophageal cancer is about 30 times higher in children with GERD compared with healthy children,” he says. “This was an alarming and completely unexpected result for us.”
He’s especially concerned about studies showing that most patients with Barrett’s esophagus report no GERD symptoms.
That’s because they experience a “burnout” of their esophagus that numbs it to discomfort. The result is what doctors call “Barrett’s iceberg,” meaning that the biggest part of the affected population is unseen.
“Children with GERD may represent a majority of this iceberg,” the gastroenterologist says. “We should try [harder] to prevent and treat GERD in youth, and also to screen more young adults with chronic GERD for Barrett’s esophagus.”
Treating GERD
Treatment for people with acid reflux and GERD – including teens – is similar, and may require lifestyle changes:
- Eat smaller, more frequent meals to prevent overfilling the stomach.
- Limit consumption of common trigger foods, such as caffeine, peppermint and chocolate. Some patients also need to cut down on fried, fatty or spicy foods.
- Doctors may also recommend prescription or over-the-counter drugs that reduce the body’s production of stomach acid, including proton pump inhibitors and H2 blockers.
- Time the last meal of the day at least three hours before bedtime so food can be digested while you’re still vertical and gravity helps keep digestive acids in the stomach. That no-eating period significantly relieved overnight GERD symptoms, a 2014 study published in the Journal of Gastroenterology and Hepatology found.
- Exercise moderately.
- Get enough sleep.
Why Treating Teens Is Hard
But these aren’t easy habits for teens to adopt. Food restrictions can set socially sensitive teens apart when they gather in fast-food restaurants and can’t eat pizza, fries and tacos.
“Teenagers with GERD need to manage their lifestyle – which can be more difficult for this group, especially as it can be more difficult for them to comprehend long-term outcomes and consequences,” says Namita Singh, MD, Kyla’s doctor and a pediatric gastroenterologist at Cedars-Sinai Medical Center in Los Angeles.
“They may need to change their diet, which makes it difficult as eating is very much a social activity,” Dr. Singh says.
What’s more, teenagers frequently snack at night and tend to stay up late.
“Sleep is so important for overall health, and we know that teenagers need more sleep than adults,” Dr. Singh says. “Getting enough sleep can difficult in this day and age, as teens are busy with school activities, as well as consumed by phones and devices.”
Playing school sports also poses a problem. The high-intensity activity often required – bouncing, running and jumping – can worsen symptoms, in part by increasing abdominal pressure, according to a 2016 study in the American Journal of Gastroenterology.
If teenagers stick to a regimen of dietary changes, adequate rest and stress reduction, as well as medication when needed, they generally respond well, both gastroenterologists say.
Exercising on an empty stomach, avoiding bouncing movements and timing anti-reflux medication for shortly before athletic activities can help active teens avoid acid reflux, the doctors said.
How Kyla Got the Right Diagnosis
For Kyla, the usual GERD treatments gave only limited relief. That’s unusual, and partly due to a second, rare gastrointestinal problem – a buildup of collagen in her intestine – that remained undiagnosed until about a year ago.
Now, she’s happily attending public school as a 7th grader, though even now she has episodes that force her to leave school early several days in a row.
She’s careful with her diet, and avoids tomato sauce and orange juice, which are triggers for her reflux. During the hours before bed, she’ll only eat saltines.
She also takes an over-the-counter proton pump inhibitor and has been instructed to find ways to reduce stress.
But “it’s always there – you feel this dull pain in your stomach, but you can’t get rid of it,” she says. “Every day, I have a little pain in my stomach.”
She doesn’t discuss it with friends, not because she’s embarrassed for them to know but because if she talks about it, she’ll think about it. Keeping her mind diverted is one way to reduce the discomfort.
Like Kyla, more teens with GERD are following through on treatment requirements, Dr. Ketan Shah says.
“Recently, I’m seeing a new wave of more health-conscious teens,” he says. “They’re the new social leaders, the ‘cool kids.’ I find this very exciting, since the power of peer pressure, which is the strongest in teens, is leading to a health revolution.”