Heartburn in Children

Not normal, and not always caused by acid reflux!

Heartburn is defined as a burning sensation in the chest caused by the regurgitation of acid contents from the stomach into the esophagus.

Heartburn is quite a common symptom among grown-ups, since 10-20% of adults suffer from it, while only 2-5% of children report having this symptom.

It is common knowledge that heartburn is associated with gastroesophageal reflux disease (GERD), commonly known as acid reflux, but very few people know that heartburn can also be caused by other conditions, such as an allergic process in the esophagus called eosinophilic esophagitis, or even an infection caused by fungus called Candida esophagitis.

The best way to explain what eosinophilic esophagitis is to call it “asthma of the esophagus” since it shares many features with asthma:

It can affect you at any point in your life,  occurs in people with food or environmental  allergies, you may have it and not know you do, and it can produce narrowing of the food pipe (wind pipe in the case of asthma) if not treated.

Presenting symptoms vary according to age and include feeding problems and extremely picky eaters in toddlers, isolated vomiting in school age children, and heartburn and difficulty swallowing in teenagers.

Some of the medications used to treat eosinophilic esophagitis are similar to those for asthma albeit they are swallowed and not inhaled.

Candida esophagitis is caused by overgrowth of a fungus that is normally present in our GI tract. Factors such as repeated use of antibiotics, inhaled or swallowed steroids, use of mouth wash or a weak immune system will allow it to grow out of control. Antifungal drugs are needed to stop the infection, such as Fluconazole.

My main goal in writing this article is to raise awareness among parents that if a child or teenager is complaining of heartburn even occasionally, it means their esophageal wall has sustained enough damage to expose their pain receptors (called nociceptors), and they need to be seen by pediatric gastroenterologist.

An upper endoscopy with biopsy will be frequently needed to differentiate between acid reflux, allergic esophagitis or Candida esophagitis.

This is very simple test done while the child is sedated where we introduce a small tube with a camera to observe the lining of the GI tract and obtain pictures and small samples called biopsies.

These biopsies are “read” by pathologists who can identify the cause of the esophagitis and allow your doctor to prescribe the correct treatment.

Heartburn can improve

If treated with over the counter medications such as ranitidine (Zantac), famotidine (Pepcid), omeprazole (Prilosec), lansoprazole (Prevacid) or esomeprazole (Nexium), however the baseline disease is usually not controlled and it will continue to advance.

That is why it is critical that any child with heartburn is evaluated by a specialist as soon as possible.

Remember, the words “heartburn” and “child” should not be mentioned in the same sentence unless the word “not” is included in the same sentence!