REFLUX (GER) OR GERD - HOW TO TELL THE DIFFERENCE

RMacLean
January, 2005

From the page about reflux, you've already learned what reflux is. Here, we will go into more detail on the different terms used to refer to reflux.  This information applies to adults as well, not just infants with reflux.  The term reflux is a shorter way of referring to GER (Gastro Esophageal Reflux) and is simply defined as the backward flow of stomach contents up the esophagus.  GER is a physiological* process that happens to everyone—young and old—from time to time, particularly after meals and many times we are not even aware it is happening.

what is GER?

When a baby or child (or anyone for that matter) is referred to as having GER, the term represents a benign condition in which the child is having frequent "reflux" episodes.  This is also called "Functional GER" and does not cause complications, lead to long term problems, affect growth or development or even necessarily require medical intervention.  The category of GER can range from reflux material simply entering the distal (bottom of the) esophagus to spitting up and even frequent projectile vomiting.  Projectile vomiting alone is not considered to be a complication and as long as no other complications arise, it is considered GER.

when is ger really called gerd?

In contrast, GER (Gastro Esophageal Reflux) is referred to as GERD (Gastro Esophageal Reflux Disease) when complications arise.  GERD is a pathological** process and the complications can be typical (failure to thrive, feeding and oral aversions, esophagitis, etc) or atypical (wheezing, pneumonia, chronic sinusitis, etc).  Patients with GERD have complications arising from their GER that necessitate medical intervention.  GERD is also referred to as "Pathogenic GER".  It is estimated that approximately one in three hundred children will present symptoms of GERD and is more common in children with neurological impairments.

what about secondary ger?

In secondary GER, there is some underlying cause of the reflux episodes, something else is going on to cause the reflux episodes.  Some examples of secondary GER would be pyloric stenosis, food is being refluxed out of the stomach but it is actually being caused by the pyloric sphincter being blocked.  Other examples of secondary GER would be food allergies, metabolic disorders, infection, NG tubes, etc.

what is silent ger?

Silent GER refers to GER or GERD without any outward or typical symptoms.  This could mean that a child isn't vomiting or appearing uncomfortable but is having reflux episodes.  Some children may swallow the refluxed material (refluxate) back down instead of throwing it up, in some kids it may not come up enough to actually come out the mouth.  This can be much more difficult to diagnose, since the most common symptoms are not present.  It can also be more damaging as the refluxate burns the esophagus on the way up and again on the way down.  Whether or not the silent reflux needs to be treated depends on the complications that are arising from it.

Laryngopharyngeal Reflux

When reflux makes it's way up all the way up through the upper sphincter and to the back of the throat causing problems with hoarseness, sore throats, chronic cough, etc, it's referred to as Laryngopharyngeal Reflux.

*Physiologic - normal, not pathologic, characteristic of or conforming to the normal functioning or state of the body or a tissue or organ.

**Pathologic - Indicative of a specific condition, not physiological.

Reviewed By Dave Olson, MD
Fellow, American Academy of Pediatrics
Graduate University of Michigan School of Medicine