GER and SIDS

August 1997

GER occurs commonly in infants. The true incidence is not known, but if apparently healthy babies were tested, probably at least 30%-50% would show some evidence of GER. GER occurs because the lower esophageal sphincter (LES; muscle to closes off the top of the stomach after you swallow to keep food in the stomach) is immature and does not tighten sufficiently to keep food and gastric fluids from running out of the stomach and up the esophagus (food tube). Clinically, babies with significant GER often spit up a lot. GER may be harmless. It usually disappears with development, often by 7-months of age, if not before.

GER is treated if it presents one of four problems: 1) chronic lung disease (gastric material is aspirated into the lungs); 2) growth failure (infants spit up so much feeding that they do not have enough nutrition for growth); 3) esophagitis (inflammation of the esophagus due to chronic stomach acid exposure); or 4) apnea (thought to be a reflex that acid in the esophagus or upper airway stimulates apnea). It is controversial how much apnea is really caused by GER. Certainly, there are some babies who have massive GER, and obvious choking associated with this. However, this is not a typical story for a SIDS death. Can lesser amounts of GER cause apnea and death? This question remains unanswered. However, I personally do not think GER is an important cause of SIDS.

Massive GER would be detectable at autopsy either as gastric material seen in the airway (aspiration) or chronic esophagitis from acid irritation of the esophagus. I believe that GER severe enough to cause death would be detectable at autopsy.

I hope this helps. Thank you.
---Tom Keens
Childrens Hospital Los Angeles