Understanding Infant Reflux: GER vs. GORD
Infant reflux, or gastroesophageal reflux (GER), is a common condition where stomach contents come back up into the food pipe (esophagus) [1.4.2]. It affects a large number of infants, with some studies showing daily regurgitation in approximately 40% of babies [1.8.1]. This usually happens because the muscle at the base of the esophagus is still developing [1.4.2]. For most, it's a temporary issue that resolves on its own within the first year [1.7.1].
However, when reflux causes significant distress, feeding difficulties, or poor weight gain, it's classified as gastroesophageal reflux disease (GORD) [1.7.1]. It is in these more severe cases that medication might be considered. Two common treatments prescribed are Gaviscon Infant and omeprazole, but they work in very different ways.
What is Gaviscon Infant and How Does It Work?
Gaviscon Infant is often considered a first-line treatment for GORD [1.2.1]. Its mechanism is physical, not chemical. The main ingredients, sodium alginate and magnesium alginate, mix with stomach contents to form a viscous gel, or 'raft' [1.11.1, 1.11.4]. This raft floats on top of the stomach's contents, creating a physical barrier that helps prevent the milk and acid from refluxing back into the esophagus [1.4.4, 1.11.4]. It essentially acts as a thickener within the stomach [1.2.1].
Key Points on Gaviscon Infant:
- Action: Thickens stomach contents to physically block reflux [1.2.1].
- Administration: Comes as a powder mixed with water or milk and given during or after a feed [1.4.2].
- Use Case: Primarily for simple regurgitation and is often the first medical step, particularly if the main symptom is frequent spitting up without significant pain [1.2.1, 1.7.4].
What is Omeprazole and How Does It Work?
Omeprazole belongs to a class of powerful drugs called Proton Pump Inhibitors (PPIs) [1.2.4]. Unlike Gaviscon, omeprazole doesn't stop the physical act of reflux. Instead, it works by decreasing the amount of acid produced by the stomach [1.3.1]. It does this by irreversibly blocking the H+/K+ ATPase enzyme system, also known as the 'proton pump,' in the stomach's parietal cells [1.10.2, 1.10.4]. By reducing acidity, it helps to heal any inflammation in the esophagus (esophagitis) caused by the refluxed acid and reduces pain [1.2.1].
Key Points on Omeprazole:
- Action: Reduces the production of stomach acid [1.3.1].
- Administration: Typically prescribed as a liquid suspension or dispersible tablets [1.2.1]. It can take up to two weeks for the full soothing effect on the esophagus to be felt, even though it starts reducing acid quickly [1.2.1].
- Use Case: Considered a second-line treatment, used when reflux is causing pain, distress, and potential damage to the esophagus (GORD) that hasn't responded to conservative measures or Gaviscon [1.2.1, 1.7.1].
Comparison Table: Omeprazole vs. Gaviscon Infant
| Feature | Gaviscon Infant | Omeprazole |
|---|---|---|
| Mechanism | Forms a physical 'raft' to block reflux [1.11.4] | Reduces stomach acid production (Proton Pump Inhibitor) [1.10.4] |
| Primary Goal | Reduce regurgitation/vomiting [1.2.1] | Reduce acid to alleviate pain and heal esophageal inflammation [1.2.1] |
| Treatment Line | First-line treatment [1.2.1] | Second-line treatment, for more severe GORD [1.2.1] |
| Common Side Effects | Constipation, diarrhea, abdominal distension [1.6.1, 1.6.2] | Headache, diarrhea, nausea, vomiting, gas [1.5.1, 1.5.3] |
| Onset of Full Effect | Immediate for physical blocking | Can take up to 2 weeks for esophageal healing and full symptom relief [1.2.1] |
| Prescription Status | Available over-the-counter but medical supervision is advised for infants under one [1.4.4, 1.6.2] | Prescription-only for infants [1.2.4, 1.3.3] |
Potential Side Effects and Risks
No medication is without risks. A common side effect reported by parents for Gaviscon Infant is constipation, and it can sometimes cause diarrhea [1.2.1, 1.6.3]. It should not be used with other feed thickeners [1.4.3]. In rare cases, it has been associated with the formation of a bezoar (a solid mass) in the stomach [1.4.1, 1.6.2].
Omeprazole and other PPIs can also have side effects. Common ones include headache, diarrhea, constipation, and nausea [1.5.2, 1.5.3]. More serious concerns with long-term use or acid suppression include a potentially increased risk of gastrointestinal infections and pneumonia, as stomach acid plays a role in killing ingested pathogens [1.3.3]. Some studies have also pointed to a possible increased risk for fractures later in childhood, though the evidence is debated [1.3.1, 1.7.4].
What Do the Guidelines Say?
Medical guidelines, such as those from the UK's National Institute for Health and Care Excellence (NICE), emphasize a 'stepped-care' approach [1.7.1].
- Reassurance & Conservative Measures: For simple reflux, parents are reassured that it's common and usually resolves by age one [1.7.3]. Simple changes like smaller, more frequent feeds, holding the baby upright after feeding, and proper burping are recommended first [1.9.3, 1.9.4].
- Thickeners/Alginates: If an infant is formula-fed and distressed, a trial of thickened formula may be suggested. For both breastfed and formula-fed babies with marked distress, a 1-2 week trial of an alginate (like Gaviscon Infant) can be considered [1.7.1, 1.7.4].
- Acid Suppressants: Acid-suppressing drugs like PPIs (omeprazole) or H2 blockers are not recommended for treating simple regurgitation. They are reserved for a 4-week trial in infants with overt regurgitation accompanied by unexplained feeding difficulties, faltering growth, or significant distressed behavior [1.7.1].
Conclusion: Which is Better?
Neither omeprazole nor Gaviscon is universally 'better'; their suitability depends on the baby's specific symptoms. Gaviscon is better for babies whose primary issue is frequent spitting up (simple regurgitation), as it physically helps keep food down [1.2.1]. Omeprazole is better for babies with GORD, where the primary issue is pain and distress caused by stomach acid, as it reduces the acid itself, allowing the esophagus to heal [1.2.1].
The choice of medication should always be made by a doctor after a thorough evaluation. Self-treating infant reflux is not recommended. Often, lifestyle and feeding adjustments are tried first and may be all that is needed to manage the symptoms until the baby's digestive system matures [1.9.4].
For more detailed guidance, consult authoritative sources like the NICE guidelines on GORD in children.
