How would you approach a teenager who complains of having heartburn a few times a week?
CARLO DiLORENZO, MD: I would first like to know a few more things about the complaints. Is there anything else going on? Is there a sensation of food coming up into the mouth? Is there any vomiting? When does the heartburn occur? Is there a family history of GI problems? All these questions would give me the information that is important in the assessment of somebody with heartburn.
Would you approach the patient differently if there had been symptoms of heartburn for many years?
CARLO DiLORENZO, MD: It does make a difference in regards to how long things have been going on. If the symptoms are new and especially severe in intensity, there may be some other cause underlying the heartburn. If the heartburn has been going on for years, it's less likely that we are dealing with a serious condition.
If a child has other gastrointestinal symptoms, such as constipation, is that consistent with simple GERD?
CARLO DiLORENZO, MD: No, then we're worried about what we call GERD plus. These extra symptoms mean that it's not just reflux. It's probably somebody with a more generalized problem involving the stomach, the small bowel and sometimes the colon as well.
If a teen does have GERD, what are some lifestyle changes he or she can make?
JANET HARNSBERGER, MD: There are a number of things that have an impact on the choice of a treatment program. At thirteen years of age, there are many changes that happen in a child's life, including acne medication and sports injuries that require treatment with anti-inflammatory medications, which can hurt the intestine. Orthodontic hardware may impair a child's ability to swallow effectively, which also might bring up some reflux.
