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Gastroesophageal Reflux Disease
Compiled from across the library · built automatically
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Standard heparin lock concentrations are 10 units/mL for accessed catheters (ports and cuffed lines), 100 units/mL for non-accessed buried ports, and 1000 units/mL for dialysis catheters. — Mark Wulkan, Pediatric Vascular Access · 24:40
Esophageal Disconnect for Severe GERD in Neurologically-Impaired Children:...
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At the 5th Annual Stay Current Pediatric Surgery Update Course in 2017, Dr. David Lanningdiscusses gastroesophageal disconnection in treatment of severe GERD in neurologically-impaired children. He touches on initial management of neurologi
video34:38 · Sep 2018
Pediatric Vascular Access
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podcast35:43 · Nov 2022
Gastroesophageal Reflux Disease
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An interactive discussion about gastroesophageal reflux disease between Jeffrey Ponsky, MD and Michael Rosen, MD. Dr. Rosen is a professor of surgery at the Cl
podcast33:57 · Jul 2026
When evaluating reflux disease surgery, you need to differentiate neurologically normal versus neurologically abnormal patients because their responses to surgery are very different BOB in Ped Surg 2023 - PAPSA Winner - Mohamad Mahmoud Qinawy, MD · 13:37
Esophagogastric Dissociation for GERD in Severe Neurodisability
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Dr. Ian Glenn and Dr. Todd Ponsky discuss an article comparing esophagogatric dissociation and laparoscopic Nissen fundoplication in patients with severe gastroesophageal reflux disease (GERD) and severe neurodisability
video2:49 · Oct 2018
Gastoesophageal Reflux: Update Course 2015
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Dr. Mac Harmon presents on gastoesophageal reflux. His discussion includes topics onsurgical approaches to GERD, AAP GERD guidelines, fundoplication and gastrostomy versus percutaneous gastrojejunostomy, laparoscopic versus open nissen fund
video30:06 · Nov 2018
Esophagogastric Dissociation for GERD in Severe Neurodisability
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Dr. Ian Glenn and Dr. Todd Ponsky discuss an article comparing esophagogatric dissociation and laparoscopic Nissen fundoplication in patients with severe gastroesophageal reflux disease (GERD) and severe neurodisability
video2:49 · Jan 2019
BOB in Ped Surg 2023 - PAPSA Winner - Mohamad Mahmoud Qinawy, MD
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Watch the PAPSA winner, Mohamad Mahmoud Qinawy, MD, present his presentation on "Comparative study of laparoscopic Nissen fundoplication vs Hill-snow procedure for treatment of gastroesophageal reflux disease in children."
video16:32 · Feb 2023
BOB Ped Surg 2023 - Mohamad Qinawy, PAPSA - Presentation
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Watch Mohamad Mahmoud Qinawy, MD, present his presentation on "Comparative study of laparoscopic Nissen fundoplication vs Hill-snow procedure for treatment of gastroesophageal reflux disease in children."
video8:09 · Feb 2023
Laparoscopic gastrostomy allows better choice of stomach location and permits primary button placement, avoiding need for second anesthetic to replace PEG with button — Jose Campos, Case-Based Journal Review: G-Tube & Fundoplication for GERD 2023 · 10:45
Case-Based Journal Review: G-Tube & Fundoplication for GERD 2023
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It is already public knowledge that thousands of articles on different pathologies are published every day and that it is very difficult to follow them.
In this format we bring you a different way of knowing what is the most up-to-date o
podcast18:19 · Sep 2023
The new GERD guidelines (joint North America and Europe) recommend treating with PPI for 2 months then attempting to wean, with goal of weaning twice yearly. — Rachel Rosen, Gastroesophageal Reflux Disease · 43:42
Pediatric Gastroesophageal Reflux Disease
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This podcast is a multidisciplinary discussion on a controversial topic, management of pediatric Gastroesophageal Reflux Disease, amongst Dr. Todd Ponsky, Dr. Rachel Rosen, and Dr. George "Whit" Holcomb.Dr. Rachel Rosen is Director of the A
podcast1:21:04 · Sep 2018
Gastroesophageal Reflux: Contemporary Management Pediatric Surgery Update...
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Dr. Timothy Kane, chief of general and thoracic surgery at Children's National Medical Center, Washington D.C., discusses gastroesophageal reflux.His presentation of clinical cases includes Collis Nissen fundoplication to lengthen the esoph
video32:14 · Sep 2018
Gastroesophageal Reflux Disease
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This podcast is a multidisciplinary discussion on a controversial topic, management of pediatric Gastroesophageal Reflux Disease, amongst Dr. Todd Ponsky, Dr. Rachel Rosen, and Dr. George "Whit" Holcomb.Dr. Rachel Rosen is Director of the A
podcast1:21:04 · Dec 2020
Gastroesopheal Reflux Disease
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An interactive discussion about gastroesophageal reflux disease between Jeffrey Ponsky, MD and Michael Rosen, MD. Dr. Rosen is a professor of surgery at the Cleveland Clinic Lerner College of Medicine, and general surgery staff in departmen
podcast33:57 · Dec 2020
GERD - (GastroEsophageal) REFLUX (Disease) in Esophageal Atresia Patients: An ERNICA animation
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Animation video [in English]. Target audience: Parents and families. The video could also be used as an explanatory tool by healthcare professionals.
This is an ERNICA animation. Please consult your own care provider for local protocols.
video4:14 · Nov 2023
Expert statements from the recordings in this collection.
Pediatric Gastroesophageal Reflux Disease
The vast majority of kids who have vomiting, respiratory symptoms, and wheezing are more likely to have oropharyngeal dysphagia and aspiration during swallowing than gastroesophageal reflux.
Rachel Rosen3:23
In infants fed every 2 to 3 hours, milk remains in the stomach for up to 2–3 hours; acid production only begins after 3 hours, so infants reflux non-acidic gastric content.
Rachel Rosen5:39
Proton pump inhibitors are not beneficial in children under the age of 1 because they reflux non-acidic milk, not acid.
Rachel Rosen5:26
Studies have shown that both H2 blockers and PPIs increase the risk of sepsis, UTIs, necrotizing enterocolitis, pneumonia, pharyngitis, upper respiratory infections, GI bugs, and C. diff in infants.
Rachel Rosen7:21
Eosinophilic esophagitis is found in about 10% of kids under age 5 who are scoped for respiratory symptoms.
Rachel Rosen9:53
In children under 5, the most common presentation of eosinophilic esophagitis is chronic cough; the second most common is vomiting or failure to thrive.
Rachel Rosen9:41
In older kids, eosinophilic esophagitis presents with chest pain, food impactions, and dysphagia.
Rachel Rosen10:08
You really need to scope every kid before they would get a Nissen because you don't want to wrap a kid who has eosinophilic esophagitis.
About 60 to 70% of kids with eosinophilic esophagitis are allergic to dairy.
Rachel Rosen12:02
Macrolides (erythromycin) are motilin agonists that make the antrum of the stomach contract and can help with vomiting; they also have an anti-inflammatory effect on the airway and lungs.
Rachel Rosen16:28
There are no great normal values for the number of reflux episodes in pediatric patients, so the best use of a probe is to correlate symptoms with reflux episodes.
Rachel Rosen17:48
The majority of kids will outgrow their oropharyngeal dysphagia by 3 to 4 months of age.
Rachel Rosen28:21
In kids with oropharyngeal dysphagia in the NICU, about 75% will get the NG tube out and not need to go on to gastrostomy.
Rachel Rosen28:42
When we looked at our own data at Boston Children's, once a gastrostomy goes in in children that aspirate from oropharyngeal dysphagia, their rates of hospitalization are about 15 times higher than if you just fed them by mouth, even in kids who aspirate all textures.
Rachel Rosen29:37
An upper GI is really not a good study for reflux; it doesn't document reflux very well because if the child's not refluxing right when the x-ray is taken, it won't show reflux.
Whit Holcomb22:32
In a study of patients who had upper GI and pH studies, the upper GI did not help with diagnosing reflux, but it did help identify an anatomical problem in about 4% of patients.
Whit Holcomb23:19
New GERD guidelines (joint North America and Europe) recommend treating with PPI for 2 months, then attempting to wean; if unable to wean, restart the drug, but the goal should be to try to wean ideally 2 times a year.
If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term.
Rachel Rosen45:31
In Kansas City's prospective randomized trial of 107 patients, neither group required a redo fundoplication for a slipped wrap; the primary reason for redo historically was transmigration of the wrap into the chest.
Whit Holcomb46:40
By doing minimal mobilization and not disrupting the phrenoesophageal membrane, we were able to drop our transmigration rate from 12% to 5%, and in our final study there was zero recurrence and zero redo fundoplication rate in both groups.
Whit Holcomb57:32
The surgical message is that we need to do less rather than more dissection around the GE junction to prevent wrap transmigration.
Whit Holcomb59:22
You've got to know where the left gastric artery is, and you've got to be sure that you are cephalad to that to ensure the wrap is at the level of the lower esophagus, not the stomach.
Whit Holcomb1:00:49
When you're looking at the post-fundoplication patient, if they have a G tube, you have to image them both ways: putting barium through the G tube and also giving them barium from above via a nasoesophageal tube to see if the esophagus is emptying.
Rachel Rosen1:02:02
A study out of Cincinnati showed that blenderized feeds are a really effective therapy for treatment of post-fundoplication retching.
Rachel Rosen1:03:07
We use a lot of erythromycin in babies who have respiratory symptoms; macrolides are motilin agonists and also have an anti-inflammatory effect for the airway and lungs.
Rachel Rosen16:28
Pyloric Botox works not only for delays in emptying but also with the sensory component that triggers retching.
Rachel Rosen54:19
Cyproheptadine (periactin) helps with gastric accommodation and can control retching in kids.
Rachel Rosen54:26
When you look at kids that tend to do the worst after Nissen, it's the kid who had a Nissen for pulmonary reasons; if they're aspirating during swallowing, their saliva pools in the esophagus over the Nissen and they continue to aspirate, so they gag, retch, and cough all the time.
Rachel Rosen49:02
The kids who are the most miserable post-Nissen are the kids that were retching pre-op, because they retch a lot post-op too.
Rachel Rosen35:28
Using an esophageal bougie at the time of fundoplication has resulted in very little need for postoperative dilation; in all our prospective studies, we've dilated one or two patients.
Whit Holcomb1:03:46