GERD Could Be Real Colic Cause

Colic, the scourge of new parents, doesn't have a definite cause or even a definite diagnosis. "At least three hours of crying at least three days a week for at least three weeks" is about as concrete as it gets.

I've written several times about colic, in Colic and Dairy Allergy and Colic From Dairy Allergies? (If you don't want to click over, the answer to the question is "maybe."

In today's Wall Street Journal Melinda Beck wrote that pediatricians are now thinking that half or more of colic cases may really be gastroesophageal reflux disease (GERD).

I've written about GERD before too, in Dairy-Free Diet Can Help GERD but Beck's article suggests that direct treatment for GERD with proton-pump inhibitors (PPIs), the strongest acid-blocking drugs, may eliminate the symptoms without need for a dairy-free diet.

But first let's go back and define GERD.

Even the terminology is confusing. Most babies have reflux -- spitting up some liquid, since the valve separating the stomach from the esophagus isn't fully closed. It usually doesn't hurt. Experts like to say these "happy spitters" are a laundry problem, not a medical problem, and no treatment is needed. Most babies outgrow this simple gastroesophageal reflux (or GER) by the time they're about 7 months old.

GER becomes more-serious GERD if the infant won't eat and stops gaining weight, vomits blood and is extremely irritable. He may be highly sensitive to stomach acid -- "just like some adults get heartburn and call 911," says Beth Anderson, founder of the Pediatric/Adolescent Gastroesophageal Reflux Association (Pager), an information group for parents. GERD babies may also choke or aspirate liquid. Acid-reducing drugs -- which run the gamut from over-the-counter antacids to H2 acid suppressors to PPIs -- won't stop the reflux but can cut the acidity, and thus the irritability, if acid is causing the problem.

Does this always work? Of course not.

What's tricky is that colic and reflux can occur together. "Those babies are sometimes put on acid-reducing medications, but they don't get better," says Jeffrey S. Hyams, a pediatric gastroenterologist at Connecticut Children's Medical Center in Hartford, and Olivia Manganello's doctor. "There's no medicine for colic except time and Mother Nature."

The problem is that PPIs are not specifically approved for children. There are a few possible side effects and no studies have been done to see if longer-term effects will emerge from their use.

Still, a possible cure for suffering and a way to help babies grow is a tempting procedure.

Bryan Vartabedian, a pediatric gastroenterologist at Texas Children's Hospital, had an epiphany when his own irritable baby improved dramatically when she was treated for reflux. He thinks about half of what's considered colic may actually be undiagnosed GERD. "We should be looking for signs of treatable conditions so babies aren't suffering needlessly," he says.