» Gastroenterology

Overcoming Reflux problems


US medical director Dr Tonie Kline briefs UK families at the Essex meeting.

Gastroesophageal (GE) Reflux has been a frequently discussed topic among those who care for people with CdLS and it is estimated that 85% of people with CdLS experience some type of reflux.

Dr. Carol Potter, a paediatric gastroenterologist and recent addition to the Scientific Advisory Council (SAC), offers some strategies for helping individuals with CdLS to overcome problems associated with reflux before resorting to surgery “This is a pretty aggressive approach to taking care of reflux . . . I think it has to not hurt to eat before you can get kids to eat and a lot of kids with CdLS have trouble with pain from reflux. Kids must be comfortable with eating so they can get to other feeding issues.”


Vomiting is a difficult problem because it requires answering numerous questions. The first issue involved with chronic vomiting is whether or not an anatomical reason exists for its occurrence. A doctor should consider and test for blockage in the gastrointestinal (GI) tract, pancreatic abnormalities, kidney problems or possibly a disease-related cause.

A physician may test for these conditions with an upper GI test (barium), a Cat Scan (CT), or an ultrasound.

Likewise, allergies could also be at the root of the vomiting. Testing for an allergic source may be difficult since skin tests and blood tests are seldom helpful. A biopsy may be the most valuable procedure if an allergy is suspected. A biopsy could also prove helpful if the vomiting is thought to be infection-related.

Any number of infections (sinus, ear, H-Pylori, etc.) could contribute to vomiting. After ruling out anatomy, allergy or infection, a biopsy should also indicate whether reflux is present. Reflux is the most likely offender.

Complications due to reflux can range from subtle to obvious. Pain can be the hardest to prove, particularly if a person has a high pain threshold, as some individuals with CdLS are known to have. However, this pain can make eating an unpleasant experience and encourage all kinds of frustrating behavior.

If it hurts too much to swallow or a person vomits more than they can intake, reflux can also result in the failure to gain weight.

Acid from reflux may also trigger serious breathing problems or aspiration. Aspiration (inhaling something other than air) is a serious problem for individuals with CdLS and can result in pneumonia.

People with feeding problems may aspirate food (through poor swallowing), saliva and other secretions, reflux acid, or a combination of these. ‘Silent’ aspiration (no tell-tale cough or vomiting) of food or secretions may get worse with fundoplication surgery. The extent of aspiration may be determined with swallow or saliva studies or a Chalasia scan.


Chronic reflux can also contribute to a serious condition known as Barrett’s Esophagus, the presence of precancerous changes in the esophagus. It is thought to only occur in an inflamed esophagus, but the condition cannot be predicted by symptoms and often requires monitoring with biopsies for accurate detection.

Therapies for reflux include reducing acid (primary treatment option since it reduces pain, improves motility, and reduces vomiting), promoting motility (movement of food through digestive system), protecting the esophagus mucosa (lining), drip-feeding into the stomach, and feeding past the stomach.