Our Family's Experience With Gastroesophageal Reflux and Esophagitis

By Linda Jacobs

Our daughter, Sarah, was born with VATER association.  She is eight years old and doing very well despite her complicated medical history.  She was born with esophageal atresia and a tracheoesophageal fistula.  On her first day of life, the two ends of her esophagus were joined together, and the fistula removed.

Sarah has had very little difficult swallowing, but has had significant gastroesophageal reflux.  She also has reactive airway disease.  Over the last few years she has had numerous medical studies to evaluate her degree of reflux, and she has had a few episodes of esophagitis.  She has been managed on a variety of medications, which have kept her respiratory and esophageal symptoms under control.

Since Sarah would always gag on liquid medications, we would crush her pills and put them in applesauce.  A few months ago she learned to swallow pills, and we rejoiced, crossing one more chore off the list!  It was so much easier to go places and less cumbersome.

However, Sarah began coughing one day, and the character of her cough began to concern us.  She also began to complain that it burned when she swallowed.  She said that she needed to cough since it felt as though something was stuck in her esophagus that needed to be cleared.

Within a day, her coughing became non-stop, she was complaining of difficulty breathing, and refused to eat or drink.  Her symptoms were confusing to us, so we went to see the pulmonary doctor who prescribed treatment for her respiratory problems.  He agreed that we should see her gastrointestinal (GI) doctor since he could not explain her other symptoms.  That afternoon Sarah had an upper GI study done (in this study, the child swallows a liquid that allows the esophagus to be seen on x-ray).  This test showed that she had developed an ulcer in the upper portion of her esophagus right above the area where the two ends of her esophagus were sewn together.

Since Sarah was on acid blocking medication, it was unlikely that reflux was cause her esophagus to ulcerate.  The GI doctor informed us that Sarah had developed what is known as a "pill ulcer."  A few days before her symptoms began, Sarah swallowed a pill, and it stopped at the area where her esophagus was sewn together.  Since the motility in her esophagus is poor from this area down, the pill sat is her esophagus and ulcerated the wall.  This could have been avoided if she had drunk a full glass of water with that pill!

In retrospect this makes a lot of sense, but we assumed that Sarah drank an adequate amount of liquid when she swallowed her pills.  As a parent of a child with special needs, it is a delicate balance to provide guidance and protection while helping the child move toward independence as they grow.  Since Sarah will be taking a variety of medications throughout her life, taking her own meds was a step toward independence.  We felt responsible for this setback but were unaware that it could ever happen.

Sarah has been on soft food, liquids, and some new medications the last week.  We are hopeful that her esophagus will heal without any complications.  She will require close monitoring for the next few months and will need some medical tests to be sure that everything has healed.

This problem could have been avoided if we had only known that it could occur and had been told that all pills/medications should be followed by a glass of water.  I'm confident that Sarah will be able to take pills again some day, but next time she'll be drinking lots of water!!