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Upper Symptoms and Causes

What are reflux (GER) and GERD?

The esophagus is the tube that carries food from your mouth to your stomach. If your child has reflux, his or her stomach contents come back up into the esophagus. Another name for reflux is gastroesophageal reflux (GER).

GERD stands for gastroesophageal reflux disease. It is a more serious and long-lasting type of reflux. If your child has reflux more than twice a week for a few weeks, it could be GERD.

What causes reflux and GERD in children?

There is a muscle (the lower esophageal sphincter) that acts as a valve between the esophagus and stomach. When your child swallows, this muscle relaxes to let food pass from the esophagus to the stomach. This muscle normally stays closed, so the stomach contents don't flow back into the esophagus.

In children who have reflux and GERD, this muscle becomes weak or relaxes when it shouldn't, and the stomach contents flow back into the esophagus. This can happen because of

  • A hiatal hernia, a condition in which the Upper part of your stomach pushes upward into your chest through an opening in your diaphragm
  • Increased pressure on the abdomen from being overweight or having obesity
  • Medicines, such as certain asthma medicines, antihistamines (which treat allergies), pain relievers, sedatives (which help put people to sleep), and antidepressants
  • Smoking or exposure to secondhand smoke
  • A previous surgery on the esophagus or Upper abdomen
  • A severe developmental delay
  • Certain neurological conditions, such as cerebral palsy
How common are reflux and GERD in children?

Many children have occasional reflux. GERD is not as common; up to 25 percent of children have symptoms of GERD.

What are the symptoms of reflux and GERD in children?

Your child might not even notice reflux. But some children taste food or stomach acid at the back of the mouth.

In children, GERD can cause

  • Heartburn, a painful, burning feeling in the middle of the chest. It is more common in older children (12 years and up).
  • Bad breath
  • Nausea and vomiting
  • Problems swallowing or painful swallowing
  • Breathing problems
  • The wearing away of teeth
How do doctors diagnose reflux and GERD in children?

In most cases, a doctor diagnoses reflux by reviewing your child's symptoms and medical history. If the symptoms do not get better with lifestyle changes and anti-reflux medicines, your child may need testing to check for GERD or other problems.

Several tests can help a doctor diagnose GERD. Sometimes doctors order more than one test to get a diagnosis. Commonly-used tests include

  • Upper GI series, which looks at the shape of your child's Upper GI (gastrointestinal) tract. You child will drink a contrast liquid called barium. For young children, the barium is mixed in with a bottle or other food. The health care professional will take several x-rays of your child to track the barium as it goes through the esophagus and stomach.
  • Esophageal pH and impedance monitoring, which measures the amount of acid or liquid in your child's esophagus. A doctor or nurse places a thin flexible tube through your child's nose into the stomach. The end of the tube in the esophagus measures when and how much acid comes back up into the esophagus. The other end of the tube attaches to a monitor that records the measurements. Your child will wear the tube for 24 hours. He or she may need to stay in the hospital during the test.
  • Upper gastrointestinal (GI) endoscopy and biopsy, which uses an endoscope, a long, flexible tube with a light and camera at the end of it. The doctor runs the endoscope down your child's esophagus, stomach, and first part of the small intestine. While looking at the pictures from the endoscope, the doctor may also take tissue samples (biopsy).
What lifestyle changes can help treat my child's reflux or GERD?

Sometimes reflux and GERD in children can be treated with lifestyle changes:

  • Losing weight, if needed
  • Eating smaller meals
  • Avoiding high-fat foods
  • Wearing loose-fitting clothing around the abdomen
  • Staying upright for 3 hours after meals and not reclining and slouching when sitting
  • Sleeping at a slight angle. Raise the head of your child's bed 6 to 8 inches by safely putting blocks under the bedposts.
What treatments might the doctor give for my child's GERD?

If changes at home do not help enough, the doctor may recommend medicines to treat GERD. The medicines work by lowering the amount of acid in your child's stomach.

Some medicines for GERD in children are over-the-counter, and some are prescription medicines. They include

  • Over-the-counter antacids
  • H2 blockers, which decrease acid production
  • Proton pump inhibitors (PPIs), which lower the amount of acid the stomach makes
  • Prokinetics, which help the stomach empty faster

If these don't help and your child still has severe symptoms, then surgery might be an option. A pediatric gastroenterologist, a doctor who treats children who have digestive diseases, would do the surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

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Recent Reviews

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Upper Clinical Trials and Studies

Treatments might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. The goal of clinical trials is to determine if a new test or treatment works and is safe. Clinical trials can also look at other aspects of care, such as improving the quality of life for people with chronic illnesses. People participate in clinical trials for a variety of reasons. Healthy volunteers say they participate to help others and to contribute to moving science forward. Participants with an illness or disease also participate to help others, but also to possibly receive the newest treatment and to have the additional care and attention from the clinical trial staff.
Rank Status Study
1 Recruiting Hyaluronic Acid Gels for Upper Lid Retraction in Active Stage Thyroid Eye Disease
Condition: Thyroid Eye Disease
Interventions: Drug: Hyaluronic Acid Gel injection;   Drug: Saline injection
Outcome Measures: Upper eyelid scleral show and marginal reflex distance 1 in mm;   Dry Eye;   Quality of life;   Complications
2 Recruiting Upper Airway Toning for Improve the Compliance of CPAP
Condition: Sleep Apnea, Obstructive
Interventions: Other: CPAP;   Procedure: Upper Airway Toning for Improve the Compliance of CPAP
Outcome Measures: CPAP compliance;   Sleep Apnea Quality of Life Index (SAQLI) Test
3 Recruiting Home Study of an Advanced Upper Limb Prosthesis
Condition: Traumatic Amputation of Arm
Intervention: Device: Advanced Upper limb prosthetic device
Outcome Measures: Change in Quality of Life (QOL) scale;   Home Use Appropriateness;   Extent of Prosthetic Use;   Trinity Amputations and Prosthetics Experience Scale (TAPES);   Activities Measure for Upper limb amputees (AM-ULA);   SF-36 V;   Neuropsychological Testing Battery;   Wong-Baker FACES Pain Rating Scale (FACES);   Jebsen-Taylor Hand Function Test (JTHFT);   University of New Brunswick Test of Prosthetic Function (UNB);   Adapted Rivermead Extended Activities Index (REAI);   Upper Extremity Functional Scale (UEFS) from the Orthotics and Prosthetics Users Survey (OPUS);   The Patient Specific Functional Scale (PSFS);   The Community Reintegration of Service Members Computer Adaptive Test (CRIS-CAT)
4 Unknown  Self-directed Upper Limb Training Using a SaeboFlex in Acute Stroke
Condition: Stroke
Intervention: Other: Self-directed Upper Limb SaeboFlex Training
Outcome Measures: Action Research Arm Test (ARAT);   Motricity Index (MI);   Motor Assessment Scale- Upper Limb Section (UL-MAS).;   Visual Analogue Scale;   Modified Barthel Index (MBI);   Stroke Impact Scale (SIS);   Berg Balance Test;   Questionnaire;   Adverse effects or events monitoring and recording
5 Unknown  Upper Arm Reahabilitation After Stroke and Video Game
Conditions: Stroke;   Cerebro-vascular Accident;   Upper Arm Disability;   Reaching;   Grasping
Interventions: Procedure: serious game reeducation;   Procedure: functional MRI
Outcome Measures: Efficacy assessment of the serious game on the recovery of the Upper limb;   Fugl Meyer Score between both groups;   Box and Block Test assessment between both groups;   Wolf Motor Function Test assessment between both groups.;   Motor Activity Log assessment between both groups;   Barthel Index and SF-36;   Functional MRI Assessment between controls and patients;   Nine Hole Peg test assessment between both groups;   tensor diffusion analysis between controls and patients
6 Recruiting EUS-FNA Versus KHB in Diagnostics of Upper Gastrointestinal Submucosal Tumors
Condition: Other Specified Disorders of Esophagus, Stomach or Duodenum
Interventions: Procedure: Key Hole Biopsy ( KHB);   Procedure: EUS-FNA
Outcome Measures: To compare the yield and success of KHB and EUS-FNA in cytological / histological and immunohistochemical diagnostics of Upper Gastrointestinal Submucosal Tumors.;   Detection of mitotic activity in case of Gastrointestinal Stromal Tumors
7 Unknown  ESTD vs. VATS for Upper Gastrointestinal Submucosal Tumors
Conditions: Upper Gastrointestinal Submucosal Tumors (SMTs);   Gastrointestinal Stromal Tumors (GISTs);   Leiomyoma
Interventions: Procedure: ESTD;   Procedure: VATS
Outcome Measures: En bloc resection;   Curative resection;   Procedure related complication;   Short-term morbidity;   Local recurrence;   Quality of life
8 Recruiting Comparison of Saphenous Vein Graft Harvested From Upper Versus Lower Leg in Coronary Artery Bypass Grafting
Conditions: Triple Vessel Disease;   Unstable Angina;   Stable Angina;   Myocardial Infarction
Interventions: Procedure: Upper leg vein harvesting;   Procedure: Lower leg vein harvesting
Outcome Measure: Endothelial preservation of saphenous vein graft
9 Recruiting Incidence of Sleep-disordered Breathing and Upper Airway Collapsibility in Postpartum Patients and Its Intervention
Conditions: Sleep Disordered Breathing;   Upper Airway Collapsibility;   Upper Airway Obstruction
Interventions: Procedure: elevated body position;   Procedure: supine body position
Outcome Measures: Lower rate of sleep disordered breathing in elevated body position;   to elucidate the anatomical and physiological risk factors that contribute in the Upper airway obstruction in post-partum patients
10 Recruiting Adverse Events During Upper Gastrointestinal Endoscopy
Conditions: Patients Need Upper Gastrointestinal Endoscopy;   Peptic Ulcer;   Gastric Cancer;   Esophagus Cancer;   Oesophagitis
Intervention:
Outcome Measure: Adverse events
11 Not yet recruiting Effect of Upper Limb Posture on Limb Volume as Expressed in Circumference Measurement in Healthy Women and in Women With Breast Cancer Related Lymphedema
Conditions: Breast Cancer;   Lymphedema
Intervention: Other: circumferential measurements in different Upper limb positions.
Outcome Measure: Circumferential Upper limb measurement
12 Recruiting Non-antibiotic Prescribing for Acute Upper Respiratory Tract Infection
Condition: Acute Upper Respiratory Tract Infection
Intervention: Drug: Amoxicillin
Outcome Measures: fever;   vomiting
13 Unknown  Automated Versus Standard Physiotherapy for Upper Limb Rehabilitation in Patients With Acquired Brain Lesions
Conditions: Vascular Accident, Brain;   Traumatic Brain Injury
Interventions: Device: Armeo Spring;   Other: conventional physiotherapy
Outcome Measures: Fugl Meyer Score for sensorymotor recovery of the Upper limb after stroke;   Upper Extremity Motor Activity Log for measuring real use of the Upper limb;   Wolf Motor Function Test for measurement of timed joint-segment movements;   Clinical Global Impression Score for the measurement of change over time of the illness' severity
14 Not yet recruiting Upper Extremity Strength in Cerebral Palsy
Condition: Cerebral Palsy
Intervention: Other: reproducibility of Upper extremity strength measurements
Outcome Measures: Inter-rater and test-retest reliability of HHD expressed as ICC value;   Inter-rater and test-retest reliability of E-link expressed as ICC value;   Inter-rater and test-retest reliability of functional strength measurements expressed as ICC value;   Inter-rater and test-retest agreement of HHD expressed as Limits of Agreement;   Inter-rater and test-retest agreement of E-Link expressed as Limits of Agreement;   Inter-rater and test-retest agreement of functional measurements expressed as Limits of Agreement
15 Recruiting Immediate Effects of Manipulation Versus Stretching on Upper Trapezius Pressure Pain Thresholds
Condition: Neurophysiological Mechanisms Manipulation
Interventions: Procedure: CT Manipulation;   Procedure: Upper trapezius stretch
Outcome Measures: Pain Pressure Threshold;   Cervical Range of Motion
16 Recruiting Upper Limbs Intervention in Multiple Sclerosis
Condition: Multiple Sclerosis
Interventions: Other: Upper limbs intervention;   Other: Usual treatment
Outcome Measures: Changes in manual dexterity;   Changes in apraxia;   Changes in grip strength;   Change in fatigue;   Upper limb functioning;   Pinch strength;   Tapping speed
17 Recruiting Upper Limbs Assessment in Children With Cerebral Palsy
Conditions: Cerebral Palsy;   Children
Intervention: Other: Assessment
Outcome Measures: Pediatric Evaluation of Disability Inventory (PEDI);   Upper limbs functionality;   Manual dexterity;   Executive function;   Handwriting assessment;   Range of motion;   Upper limbs strength
18 Recruiting The Development of Upper Extremity Rehabilitation Program Using Virtual Reality for the Stroke Patients
Condition: Upper Extremity Dysfunction After the Stroke
Interventions: Other: Virtual reality program for Upper extremity rehabilitation;   Other: standard occupational therapy
Outcome Measures: Fugl-Meyer Upper extremity scale;   brunnström stage;   Modified Barthel Index;   Medical Research Council (MRC) Scale for Muscle Strength;   Euroqol(EQ)-5D;   Virtual reality kinematic data;   questionnaire
19 Recruiting Hand Transplantation for Treatment of Dominant Hand or Bilateral Hand Amputees
Conditions: Upper Extremity Amputation;   Hand Amputation
Intervention: Procedure: Hand transplantation
Outcome Measures: Outcomes of hand transplantation;   Efficacy and optimization of the immune suppression protocol;   Procedural outcomes of hand transplantation;   Functional outcomes of hand transplantation;   Psychosocial outcomes of hand transplantation;   Financial and economic aspects of hand transplantation
20 Recruiting Transcranial Direct Current Stimulation Combined Sensory Modulation Intervention in Chronic Stroke Patients
Condition: Stroke
Interventions: Device: tDCS;   Drug: Epidermis anesthesia;   Drug: sham anesthesia;   Other: Repeated passive movement;   Device: sham tDCS
Outcome Measures: Change from baseline Fugl Meyer Assessment(FMA)Upper extremities subscale after intervention;   Change from baseline Active joint activity after intervention;   Change from baseline Muscle tone after intervention;   Change from baseline research arm test (ARAT) after intervention;   Change from baseline Barthel Index(BI) after intervention;   Change from baseline Patient Health Questionnaire (PHQ-9) after intervention;   Change from baseline fMRI activation after intervention;   Change from baseline Diffusion Spectrum Imaging after intervention;   Change from baseline research arm test (ARAT) at 3 months after intervention;   Change from baseline research arm test (ARAT) at 6 months after intervention;   Change from baseline Barthel Index(BI) at 3 months after intervention;   Change from baseline Patient Health Questionnaire (PHQ-9) at 3 months after intervention;   Change from baseline Barthel Index(BI) at 6 months after intervention;   Change from baseline Patient Health Questionnaire (PHQ-9) at 6 months after intervention;   Change from baseline Fugl Meyer Assessment(FMA)Upper extremities subscale at 3 months after intervention;   Change from baseline Active joint activity at 3 months after intervention;   Change from baseline Muscle tone at 3 months after intervention;   Change from baseline Fugl Meyer Assessment(FMA)Upper extremities subscale at 6 months after intervention;   Change from baseline Active joint activity at 6 months after intervention;   Change from baseline Muscle tone at 6 months after intervention