# Gastroesophageal Reflux Disease — GCMD Library living collection

Everything in the library about GERD — built automatically from dossiers that name it.

Updated: n/a · 7 episodes · 175 cited statements

## Episodes
### Surgical Management
- [Esophageal Disconnect for Severe GERD in Neurologically-Impaired Children:...](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409) — video · 34:38 · [machine version](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409.md)

### Evidence & Research
- [Esophagogastric Dissociation for GERD in Severe Neurodisability](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563) — video · 2:49 · [machine version](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563.md)
- [Gastoesophageal Reflux: Update Course 2015](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670) — video · 30:06 · [machine version](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670.md)
- [Esophagogastric Dissociation for GERD in Severe Neurodisability](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962) — video · 2:49 · [machine version](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962.md)

### In-Depth Reviews
- [Pediatric Gastroesophageal Reflux Disease](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359) — podcast · 81:04 · [machine version](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359.md)
- [Gastroesophageal Reflux: Contemporary Management Pediatric Surgery Update...](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428) — video · 32:14 · [machine version](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428.md)
- [Gastroesophageal Reflux Disease](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289) — podcast · 81:04 · [machine version](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=0) Introduction and Guest Introductions (Ep 7)
- [2:49](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=169) Initial Workup of Infant with Vomiting and Respiratory Symptoms (Ep 7)
- [8:20](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=500) Eosinophilic Esophagitis as a Masquerader (Ep 7)
- [13:20](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=800) Role of Proton Pump Inhibitors in Infants (Ep 7)
- [20:00](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1200) Medical Management Strategies (Ep 7)
- [28:00](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1680) NICU Premature Infant Management (Ep 7)
- [35:00](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2100) Diagnostic Testing: Upper GI and pH Impedance (Ep 7)
- [41:40](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2500) Rome IV Classification and Reflux Hypersensitivity (Ep 7)
- [50:00](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3000) Surgical Technique: Minimal Mobilization Nissen (Ep 7)
- [60:00](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3600) Post-Fundoplication Retching Management (Ep 7)
- [70:00](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4200) Failed Fundoplication and Redo Surgery (Ep 7)
- [75:00](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4500) Rumination Syndrome and Esophageal Dissociation (Ep 7)
- [0:00](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=0) Introduction and case presentation: 6-month-old with vomiting and respiratory symptoms (Ep 1)
- [2:49](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=169) Initial workup: ruling out oropharyngeal dysphagia and food allergy (Ep 1)
- [8:20](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=500) Proton pump inhibitors in infants: ineffective and harmful (Ep 1)
- [12:30](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=750) Endoscopy to rule out eosinophilic esophagitis; use of macrolides (Ep 1)
- [17:11](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=1031) Role of upper GI and when to suspect anatomic problems (Ep 1)
- [24:25](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=1465) NICU preemie with feeding intolerance: NG vs. G-tube timing (Ep 1)
- [34:57](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=2097) Diagnostic value of NJ trial and moving away from pH-impedance (Ep 1)
- [40:10](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=2410) When pH-impedance is useful: Rome IV categories in older children (Ep 1)
- [44:50](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=2690) Duration of PPI therapy and monitoring (Ep 1)
- [50:00](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3000) The 'perfect Nissen': minimal mobilization to prevent wrap migration (Ep 1)
- [56:40](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3400) Post-fundoplication retching: workup and management (Ep 1)
- [61:40](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3700) Neurologically impaired patients and indications for fundoplication (Ep 1)
- [70:00](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=4200) Failed fundoplication: when to redo and alternative procedures (Ep 1)
- [75:20](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=4520) Rumination syndrome: a critical masquerader (Ep 1)
- [0:01](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1) Case 1: 4-year-old with recurrent reflux after fundoplication (Ep 2)
- [6:20](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=380) Case 2: 9-year-old with bloody hematemesis and erosive esophagitis (Ep 2)
- [10:45](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=645) Background and surgical technique overview (Ep 2)
- [17:37](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1057) Detailed surgical technique and video demonstration (Ep 2)
- [26:45](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1605) Series results and outcomes (Ep 2)
- [30:37](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1837) Panel discussion on indications and complications (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=0) Diagnostic Testing for Gastroesophageal Reflux: Impedance Probes, pH Studies, and Upper GI Series (Ep 3)
- [5:57](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=357) Clinical Case: Three-Year-Old with Hiatal Hernia and Growth Failure (Ep 3)
- [10:51](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=651) Paraesophageal Hernia in a Ten-Month-Old: Type 2 Hiatal Hernia Management (Ep 3)
- [13:55](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=835) Gastroschisis Patient with Reflux: Laparoscopic Approach After Prior Abdominal Surgery (Ep 3)
- [18:56](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1136) Redo Fundoplication: Laparoscopic Versus Open Approach (Ep 3)
- [21:31](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1291) Comparative Outcomes: Laparoscopic Versus Open Fundoplication (Ep 3)
- [26:47](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1607) Gastric Emptying and Pyloroplasty: Indications and Alternatives (Ep 3)
- [0:04](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=4) Introduction and Historical Context of Esophagogastric Dissociation (Ep 4)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "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 Rosen (clinical) [Ep 1 · 3:23](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=203)
- "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 Rosen (clinical) [Ep 1 · 5:39](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=339)
- "Proton pump inhibitors are not beneficial in children under the age of 1 because they reflux non-acidic milk, not acid." — Rachel Rosen (clinical) [Ep 1 · 5:26](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=326)
- "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 Rosen (epidemiological) [Ep 1 · 7:21](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=441)
- "Eosinophilic esophagitis is found in about 10% of kids under age 5 who are scoped for respiratory symptoms." — Rachel Rosen (epidemiological) [Ep 1 · 9:53](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=593)
- "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 Rosen (clinical) [Ep 1 · 9:41](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=581)
- "In older kids, eosinophilic esophagitis presents with chest pain, food impactions, and dysphagia." — Rachel Rosen (clinical) [Ep 1 · 10:08](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=608)
- "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." — Rachel Rosen (guideline) [Ep 1 · 10:54](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=654)
- "About 60 to 70% of kids with eosinophilic esophagitis are allergic to dairy." — Rachel Rosen (epidemiological) [Ep 1 · 12:02](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=722)
- "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 Rosen (clinical) [Ep 1 · 16:28](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=988)
- "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 Rosen (clinical) [Ep 1 · 17:48](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=1068)
- "The majority of kids will outgrow their oropharyngeal dysphagia by 3 to 4 months of age." — Rachel Rosen (clinical) [Ep 1 · 28:21](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=1701)
- "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 Rosen (epidemiological) [Ep 1 · 28:42](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=1722)
- "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 Rosen (epidemiological) [Ep 1 · 29:37](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=1777)
- "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 Holcomb (clinical) [Ep 1 · 22:32](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=1352)
- "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 Holcomb (epidemiological) [Ep 1 · 23:19](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=1399)
- "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." — Rachel Rosen (guideline) [Ep 1 · 43:42](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=2622)
- "If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term." — Rachel Rosen (clinical) [Ep 1 · 45:31](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=2731)
- "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 Holcomb (epidemiological) [Ep 1 · 46:40](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=2800)
- "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 Holcomb (epidemiological) [Ep 1 · 57:32](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3452)
- "The surgical message is that we need to do less rather than more dissection around the GE junction to prevent wrap transmigration." — Whit Holcomb (clinical) [Ep 1 · 59:22](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3562)
- "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 Holcomb (clinical) [Ep 1 · 60:49](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3649)
- "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 Rosen (clinical) [Ep 1 · 62:02](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3722)
- "A study out of Cincinnati showed that blenderized feeds are a really effective therapy for treatment of post-fundoplication retching." — Rachel Rosen (clinical) [Ep 1 · 63:07](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3787)
- "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 Rosen (clinical) [Ep 1 · 16:28](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=988)
- "Pyloric Botox works not only for delays in emptying but also with the sensory component that triggers retching." — Rachel Rosen (clinical) [Ep 1 · 54:19](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3259)
- "Cyproheptadine (periactin) helps with gastric accommodation and can control retching in kids." — Rachel Rosen (clinical) [Ep 1 · 54:26](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3266)
- "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 Rosen (clinical) [Ep 1 · 49:02](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=2942)
- "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 Rosen (clinical) [Ep 1 · 35:28](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=2128)
- "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 Holcomb (epidemiological) [Ep 1 · 63:46](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3826)
- "Patients who ruminate describe vomiting 50 to 100 times a day, typically within minutes of starting a meal or for the hour after a meal; esophageal motility study shows simultaneous contraction of the stomach with bolus movement up into the esophagus." — Rachel Rosen (clinical) [Ep 1 · 78:58](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=4738)
- "If you wrap patients who ruminate, they continue to do this even with a wrap in place, so fundoplication does not help." — Rachel Rosen (clinical) [Ep 1 · 79:31](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=4771)
- "When you look at rates of reflux post-Nissen, it's somewhere between 10 and 20 reflux episodes per 24-hour period on impedance probe, and if I see that, I'm pretty happy that the Nissen is still doing its job." — Rachel Rosen (clinical) [Ep 1 · 71:39](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=4299)
- "Being able to use blenderized food instead of formula has really changed our rates of needing to think about fundoplication, because everything we're putting through the gastrostomy tube is so heavy and migrates to the antrum away from the LES and cardia." — Rachel Rosen (clinical) [Ep 1 · 52:39](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3159)
- "There are three Rome IV diagnostic categories for older children with chest pain or heartburn: non-erosive reflux disease (NERD, abnormal acid burden with normal scope), reflux hypersensitivity (normal acid burden but symptom correlation with reflux), and functional heartburn (normal scope, normal acid, no symptom correlation)." — Rachel Rosen (guideline) [Ep 1 · 40:54](https://qa.library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=2454)
- "Esophagogastric dissociation was historically considered a last resort operation when Nissen fundoplication fails." — Todd Ponsky (host_summary) [Ep 4 · 0:14](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=14)
- "Esophagogastric dissociation is being suggested as an upfront primary operation for a small subset of patients with severe neurologic impairment." — Todd Ponsky (host_summary) [Ep 4 · 0:24](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=24)
- "In the study, operative failure was defined as either recurrence of preoperative reflux symptoms or requirement of additional anti-reflux surgery." — Ian Glenn (host_summary) [Ep 4 · 1:01](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=61)
- "The esophagogastric dissociation group had a 4% operative failure rate." — Ian Glenn (host_summary) [Ep 4 · 1:13](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=73)
- "The Nissen fundoplication group had a 21% operative failure rate." — Ian Glenn (host_summary) [Ep 4 · 1:13](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=73)
- "The difference in operative failure rates between esophagogastric dissociation and Nissen fundoplication was not statistically significant." — Ian Glenn (host_summary) [Ep 4 · 1:21](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=81)
- "17% of patients in the esophagogastric dissociation group continued to require anti-reflux medications after surgery." — Ian Glenn (host_summary) [Ep 4 · 1:23](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=83)
- "54% of patients in the Nissen fundoplication group continued to require anti-reflux medications after surgery." — Ian Glenn (host_summary) [Ep 4 · 1:23](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=83)
- "The difference in continued requirement for anti-reflux medications between groups was statistically significant." — Ian Glenn (host_summary) [Ep 4 · 1:23](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=83)
- "Caregiver-evaluated quality of life and symptom scores were the same between the esophagogastric dissociation and Nissen groups." — Ian Glenn (host_summary) [Ep 4 · 1:39](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=99)
- "The lack of statistical significance in operative failure rates could represent a type 2 error where the sample size was too small to detect an actual difference." — Ian Glenn (host_summary) [Ep 4 · 2:03](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=123)
- "A multi-center study will likely be needed to fully understand the comparative effectiveness of esophagogastric dissociation versus Nissen fundoplication." — Todd Ponsky (opinion) [Ep 4 · 2:12](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=132)
- "Leaks and strictures are the primary concerns that prevent most surgeons from performing esophagogastric dissociation." — Todd Ponsky (opinion) [Ep 4 · 2:15](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=135)
- "The study examined perioperative factors including OR time, length of hospital stay, need for ICU stay, and time to full feeds, finding statistically significant differences following expected trends." — Ian Glenn (host_summary) [Ep 4 · 2:26](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=146)
- "The study did not report on leaks, strictures, or long-term requirement for additional surgeries other than anti-reflux operations." — Ian Glenn (host_summary) [Ep 4 · 2:39](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=159)
- "The vast majority of kids who have vomiting, respiratory symptoms, wheezing are more likely to have oropharyngeal dysphagia and aspiration during swallowing than gastroesophageal reflux." — Rachel Rosen (clinical) [Ep 7 · 3:23](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=203)
- "The peak age of reflux is between 4 and 6 months of age." — Rachel Rosen (epidemiological) [Ep 7 · 4:18](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=258)
- "In children under the age of 1, proton pump inhibitors are not beneficial because these kids reflux non-acidic gastric content (milk)." — Rachel Rosen (clinical) [Ep 7 · 5:26](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=326)
- "Normal gastric emptying of infants takes 2 to 3 hours; acid production only starts after the 3 hour mark when the stomach is empty." — Rachel Rosen (clinical) [Ep 7 · 5:45](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=345)
- "Studies have shown both with H2 blockers and PPIs you can get sepsis, UTIs, necrotizing enterocolitis, pneumonias, pharyngitis, upper respiratory infections, and C. diff in young children." — Rachel Rosen (clinical) [Ep 7 · 7:21](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=441)
- "In kids under the age of 5, the most common presentation of eosinophilic esophagitis is chronic cough." — Rachel Rosen (clinical) [Ep 7 · 9:27](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=567)
- "When you scope all kids under the age of 5 who are presenting with respiratory symptoms, you'll find eosinophilic esophagitis in about 10% of kids." — Rachel Rosen (epidemiological) [Ep 7 · 9:53](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=593)
- "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." — Rachel Rosen (guideline) [Ep 7 · 10:54](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=654)
- "In about 60 to 70% of kids with eosinophilic esophagitis, the most likely allergen is dairy." — Rachel Rosen (epidemiological) [Ep 7 · 11:57](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=717)
- "Macrolides like erythromycin are motilin agonists that make the antrum of the stomach contract and help with vomiting, plus they have anti-inflammatory effects for the airway and lungs." — Rachel Rosen (clinical) [Ep 7 · 16:28](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=988)
- "There are no great normal values for the number of reflux episodes in pediatric patients, making pH impedance interpretation difficult." — Rachel Rosen (clinical) [Ep 7 · 17:48](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1068)
- "Reflux in Dr. Rosen's opinion is rarely a cause of failure to thrive and respiratory symptoms in infants." — Rachel Rosen (opinion) [Ep 7 · 19:18](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1158)
- "The majority of kids with oropharyngeal dysphagia will outgrow it by 3 to 4 months of age according to a study in JPGN." — Rachel Rosen (clinical) [Ep 7 · 28:21](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1701)
- "In kids who aspirate from oropharyngeal dysphagia, rates of hospitalization after gastrostomy placement are about 15 times higher than if you just fed them by mouth, even in kids who aspirate all textures." — Rachel Rosen (epidemiological) [Ep 7 · 29:37](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1777)
- "In Boston Children's data, about 75% of NICU babies with severe dysphagia managed with NG tubes will not need to go on to gastrostomy." — Rachel Rosen (epidemiological) [Ep 7 · 28:42](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1722)
- "An upper GI study does not document reflux very well because if the child's not refluxing right when the x-ray is taken, it won't show reflux." — Whit Holcomb (clinical) [Ep 7 · 22:38](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1358)
- "In a large study at Children's Mercy, upper GI identified anatomical problems in about 4% of patients." — Whit Holcomb (epidemiological) [Ep 7 · 23:17](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1397)
- "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 (guideline) [Ep 7 · 43:42](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2622)
- "If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term." — Rachel Rosen (clinical) [Ep 7 · 45:31](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2731)
- "In Dr. Holcomb's prospective randomized trial of 107 patients, neither group required a redo fundoplication for a slipped wrap using minimal mobilization technique." — Whit Holcomb (clinical) [Ep 7 · 46:40](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2800)
- "The primary reason for redo fundoplication is transmigration of the wrap into the chest." — Whit Holcomb (clinical) [Ep 7 · 46:43](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2803)
- "Before adopting minimal mobilization technique, Children's Mercy had a 12% transmigration rate which dropped to 5% after the technique change." — Whit Holcomb (epidemiological) [Ep 7 · 57:23](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3443)
- "The key technical point is that the fundoplication wrap must be cephalad to the left gastric artery to ensure it's at the level of the lower esophagus rather than the stomach." — Whit Holcomb (clinical) [Ep 7 · 60:49](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3649)
- "Kids who present with aspiration during swallowing and then get a Nissen tend to do worse because their saliva pools in their esophagus over the Nissen or they continue to aspirate their saliva." — Rachel Rosen (clinical) [Ep 7 · 49:02](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2942)
- "Blenderized feeds through gastrostomy tubes have really changed management of reflux because the food is heavier and migrates to the antrum away from the LES and cardia." — Rachel Rosen (clinical) [Ep 7 · 52:39](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3159)
- "A study from Cincinnati showed that blenderized feeds are a really effective therapy for treatment of post-fundoplication retching." — Rachel Rosen (clinical) [Ep 7 · 63:11](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3791)
- "Pyloric Botox works not only for delays in emptying but also with the sensory component that triggers retching." — Rachel Rosen (clinical) [Ep 7 · 54:19](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3259)
- "Cyproheptadine (Periactin) helps with gastric accommodation and can control retching in children." — Rachel Rosen (clinical) [Ep 7 · 54:26](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3266)
- "Kids who wretch preoperatively will likely wretch postoperatively, and families should be counseled about this." — Rachel Rosen (clinical) [Ep 7 · 35:28](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2128)
- "Using an esophageal bougie at the time of fundoplication prevents the wrap from being too tight and reduces need for postoperative dilation." — Whit Holcomb (clinical) [Ep 7 · 63:42](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3822)
- "Post-fundoplication patients should have 10-20 reflux episodes per 24 hours on impedance probe, which is acceptable and indicates the Nissen is still functioning." — Rachel Rosen (clinical) [Ep 7 · 71:44](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4304)
- "Rome IV defines three categories: non-erosive reflux disease (NERD - abnormal acid burden, normal scope), reflux hypersensitivity (normal acid burden but symptoms correlate with reflux), and functional heartburn (no correlation between symptoms and reflux)." — Rachel Rosen (guideline) [Ep 7 · 40:54](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2454)
- "Patients with rumination syndrome describe vomiting 50-100 times a day, typically within minutes of starting a meal or for the hour after a meal." — Rachel Rosen (clinical) [Ep 7 · 78:40](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4720)
- "On esophageal motility study, rumination shows simultaneous contraction of the stomach with bolus movement up into the esophagus." — Rachel Rosen (clinical) [Ep 7 · 79:13](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4753)
- "If you wrap patients with rumination syndrome, they continue to ruminate even with a wrap in place." — Rachel Rosen (clinical) [Ep 7 · 79:31](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4771)
- "Gastric stimulation may work through a sensory effect rather than purely a motility effect, as some patients improve without improvements in motility." — Rachel Rosen (opinion) [Ep 7 · 68:04](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4084)
- "Botox doesn't reliably improve gastric emptying but helps significantly with retching, suggesting a sensory mechanism." — Rachel Rosen (clinical) [Ep 7 · 68:18](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4098)
- "Esophagogastric dissociation was historically thought of as a last resort operation when Nissen fundoplication won't work." — Todd Ponsky (host_summary) [Ep 6 · 0:14](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=14)
- "Esophagogastric dissociation is now being suggested as an upfront primary operation for a small subset of patients with severe neurologic impairment." — Todd Ponsky (host_summary) [Ep 6 · 0:24](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=24)
- "The study compared patients with severe GERD and neurologic disability, half undergoing esophagogastric dissociation and half undergoing laparoscopic Nissen." — Ian Glenn (host_summary) [Ep 6 · 0:48](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=48)
- "Primary outcome was operative failure, defined as either recurrence of preoperative reflux symptoms or requirement of additional anti-reflux surgery." — Ian Glenn (host_summary) [Ep 6 · 1:01](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=61)
- "There was a 4% failure rate in the esophagogastric dissociation group and a 21% failure rate in the Nissen group." — Ian Glenn (host_summary) [Ep 6 · 1:13](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=73)
- "The difference in failure rates between esophagogastric dissociation (4%) and Nissen (21%) was not statistically significant." — Ian Glenn (host_summary) [Ep 6 · 1:21](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=81)
- "17% of patients in the esophagogastric dissociation group continued to require anti-reflux medications after surgery, compared to 54% in the Nissen group." — Ian Glenn (host_summary) [Ep 6 · 1:23](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=83)
- "The difference in continued requirement for anti-reflux medications (17% vs 54%) was statistically significant." — Ian Glenn (host_summary) [Ep 6 · 1:29](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=89)
- "Caregiver-evaluated quality of life and symptom scores were the same between the two groups with no statistically significant difference." — Ian Glenn (host_summary) [Ep 6 · 1:39](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=99)
- "The lack of statistical significance in failure rates could potentially be a type 2 error where there was actually a difference but the sample size was too small to detect it." — Ian Glenn (host_summary) [Ep 6 · 2:03](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=123)
- "A multi-center study will probably be needed to really understand the difference between these procedures." — Todd Ponsky (opinion) [Ep 6 · 2:12](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=132)
- "The study did not look at complication rates such as leaks and strictures, which are the main concern for why most surgeons don't perform esophagogastric dissociation." — Todd Ponsky (clinical) [Ep 6 · 2:16](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=136)
- "Esophagogastric dissociation is a much bigger surgery than Nissen fundoplication." — Ian Glenn (clinical) [Ep 6 · 2:24](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=144)
- "The study examined perioperative factors including time in the OR, length of hospital stay, need for ICU stay, and time to full feeds, with statistically significant differences following expected trends." — Ian Glenn (host_summary) [Ep 6 · 2:26](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=146)
- "The study did not report on leaks, strictures, or long-term requirement for additional surgeries other than anti-reflux operations." — Ian Glenn (host_summary) [Ep 6 · 2:39](https://qa.library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=159)
- "Neurologically impaired children have a higher incidence of reflux disease and higher failure rate when treated with fundoplication" — Todd Ponsky (host_summary) [Ep 2 · 10:48](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=648)
- "Continuous gastrostomy feeds may eliminate vomiting but patients can still have severe reflux with erosive esophagitis and discomfort" — Todd Ponsky (clinical) [Ep 2 · 7:23](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=443)
- "Redo fundoplication with hiatal hernia repair is a 30-minute operation without cutting the stomach or dissociating the esophagus, which have significant morbidity" — Steve (clinical) [Ep 2 · 2:43](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=163)
- "True hiatal hernias in 6-month-old infants are very unusual and not common" — Steve (clinical) [Ep 2 · 4:00](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=240)
- "Large hiatal hernia at first operation may complicate esophagogastric disconnect by allowing small bowel to herniate into chest" — David (clinical) [Ep 2 · 4:40](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=280)
- "The Kansas technique for fundoplication, which preserves esophagophrenic ligament, may leave better options for later disconnect compared to wide hiatal dissection" — David (clinical) [Ep 2 · 4:50](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=290)
- "After 2-3 failed fundoplications, disconnect becomes a very attractive third option" — Steve (opinion) [Ep 2 · 7:49](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=469)
- "Many neurologically impaired children have life expectancy of 20-40 years, and adult surgeons may not be excited to inherit patients who have had 4 redo fundoplications" — Dan (opinion) [Ep 2 · 8:13](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=493)
- "Primary disconnect patients seem to have a bumpier postoperative course compared to those done after multiple fundoplications, though this is anecdotal without statistical power" — Steve (clinical) [Ep 2 · 8:53](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=533)
- "Esophageal disconnect was introduced by Bianchi in a 1997 paper as a rescue operation for children with failed fundoplication" — Todd Ponsky (host_summary) [Ep 2 · 11:40](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=700)
- "European results from Manchester show disconnect effectively cures reflux and respiratory complications, improves nutrition, and dramatically improves quality of life for patients and caregivers" — Todd Ponsky (host_summary) [Ep 2 · 13:20](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=800)
- "Retrospective comparison shows dissociation is associated with increased OR time, increased length of stay, and increased time to full feeds, but improved reflux results and lower failure rates compared to fundoplication" — Todd Ponsky (host_summary) [Ep 2 · 14:10](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=850)
- "Danielson's Rochester series of 27 patients (mix of children and adults) showed disconnect is definitive treatment, but only 3 had prior fundoplication so 24 were de novo procedures" — Todd Ponsky (host_summary) [Ep 2 · 15:00](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=900)
- "Both vagus nerves can be preserved during disconnect and no pyloroplasty is needed, with no gastric emptying problems observed" — Todd Ponsky (clinical) [Ep 2 · 16:40](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1000)
- "Roux limb length should be 25-30 centimeters; shorter limbs risk bile reflux into the stomach" — Dan (clinical) [Ep 2 · 18:04](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1084)
- "One patient had bile refluxing into stomach post-operatively, confirmed on contrast study, due to inadequate Roux limb length" — Dan (clinical) [Ep 2 · 17:37](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1057)
- "Mesenteric defects, particularly Peterson's defect, must be closed to prevent internal hernias" — Todd Ponsky (clinical) [Ep 2 · 18:54](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1134)
- "Prophylactic antibiotics for several days post-operatively are used, treating the case like perforated appendicitis, due to theoretical contamination when crossing the esophagus near liver parenchyma" — Todd Ponsky (clinical) [Ep 2 · 19:10](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1150)
- "Contrast study is typically done at 3 days post-operatively, though some de novo patients have been fed without imaging if doing very well" — Todd Ponsky (clinical) [Ep 2 · 19:40](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1180)
- "Low threshold for re-imaging or returning to OR if concerned about leak, similar to bariatric surgery practice" — Todd Ponsky (clinical) [Ep 2 · 20:01](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1201)
- "Some patients can start feeds immediately post-operatively since feeds go into stomach and downstream, not past the esophagojejunostomy" — Todd Ponsky (clinical) [Ep 2 · 20:29](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1229)
- "Operating from patient's right side (as in bariatric surgery) rather than between legs allows better access and avoids lithotomy position" — David (clinical) [Ep 2 · 21:26](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1286)
- "Hand-sewn esophagojejunostomy with interrupted sutures is preferred over stapled anastomosis, especially in smaller children, for security" — Todd Ponsky (clinical) [Ep 2 · 22:30](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1350)
- "4-0 Vicryl suture is used for esophagojejunostomy; PDS or silk could also be used" — Todd Ponsky (clinical) [Ep 2 · 23:50](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1430)
- "One complication involved colon flipping around Roux limb causing obstruction in a patient with neurologic impairment and global motility problems; resolved by pulling colon back and tacking it to Roux limb" — Dan (clinical) [Ep 2 · 24:08](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1448)
- "In 24-patient series, average age was 9 years (range 14 months to 17 years), average weight 8-57 kg, average operative time 474 minutes, average length of stay 12 days" — Todd Ponsky (clinical) [Ep 2 · 26:45](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1605)
- "Long length of stay (12 days average) is related to complex patient population with respiratory issues, need for pulmonary toilet, and mobilization challenges, not the operation itself" — Todd Ponsky (clinical) [Ep 2 · 26:45](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1605)
- "Results show minimal post-operative retching and vomiting in the series" — Todd Ponsky (clinical) [Ep 2 · 28:20](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1700)
- "No patients in the series were readmitted for aspiration-related events or respiratory problems related to reflux" — Todd Ponsky (clinical) [Ep 2 · 29:10](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1750)
- "Caregivers report dramatic improvement in quality of life, with some mothers in tears saying 'you've given me my child back'" — Todd Ponsky (clinical) [Ep 2 · 28:40](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1720)
- "Complications in the series include internal hernias (one requiring bowel resection after delayed presentation), one death from gram-negative sepsis with no leak on contrast study, and several readmissions" — Todd Ponsky (clinical) [Ep 2 · 30:00](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1800)
- "Patients can continue to take food by mouth for pleasure after disconnect, including ice cream and supplemental feeds, though they may not maintain weight on oral intake alone" — Todd Ponsky (clinical) [Ep 2 · 30:20](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1820)
- "In neurologically normal patients who want to eat by mouth after disconnect, they will be able to eat but probably cannot maintain weight without supplemental nighttime feeds" — Todd Ponsky (clinical) [Ep 2 · 25:05](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1505)
- "Patients who have had total gastrectomy with Roux-en-Y reconstruction can still eat by mouth but cannot maintain weight without supplementation" — Todd Ponsky (clinical) [Ep 2 · 25:50](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1550)
- "Redo Nissen fundoplication in neurologically impaired children is typically a 2-hour operation with discharge in 24-48 hours, significantly less morbidity than disconnect" — Steve (clinical) [Ep 2 · 33:07](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1987)
- "Having a Roux limb is not necessarily benign long-term and carries significant potential complications" — Steve (opinion) [Ep 2 · 32:50](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=1970)
- "Patients who fail fundoplication may receive GJ tubes and not return to surgeon, so true long-term fundoplication failure rates may be underestimated" — Steve (opinion) [Ep 2 · 33:35](https://qa.library.globalcastmd.com/watch/esophageal-disconnect-for-severe-gerd-in-neurologically-impaired-children-409?t=2015)
- "Multiple-channel intraluminal impedance probes are the best test for quantifying the presence and severity of non-acid reflux over time." — Tim (clinical) [Ep 3 · 0:08](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=8)
- "Impedance probes are not readily available to all practitioners, particularly outside major centers, and even within the United States not all pediatric gastroenterologists perform them." (clinical) [Ep 3 · 0:38](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=38)
- "pH probes are more readily available and more commonly used than impedance probes for reflux evaluation." (clinical) [Ep 3 · 0:38](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=38)
- "Gastroenterologists report they can perform impedance studies in neonates, although they are rarely requested." — Tim (clinical) [Ep 3 · 1:04](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=64)
- "Surgical decisions to operate for reflux are typically based on clinical symptoms rather than objective testing." — Tim (clinical) [Ep 3 · 1:04](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=64)
- "In a study from the speaker's institution examining fundoplications and correlating upper GI studies with pH studies, the upper GI influenced management in 4% of cases." — Tim (epidemiological) [Ep 3 · 4:20](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=260)
- "Of the 4% of cases where upper GI influenced management, 80% were due to detection of malrotation." — Tim (epidemiological) [Ep 3 · 4:20](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=260)
- "The 4% rate of upper GI studies influencing management can be interpreted two ways: either 4% is significant enough to warrant routine pre-operative upper GI, or 4% is low enough that malrotation can be evaluated intraoperatively during fundoplication." — Tim (opinion) [Ep 3 · 4:20](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=260)
- "If pre-operative upper GI demonstrates malrotation in a patient being evaluated for fundoplication, management changes from fundoplication to Ladd procedure with proton pump inhibitors instead." — Tim (clinical) [Ep 3 · 5:26](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=326)
- "Upper GI studies can also detect duodenal web or duodenal stenosis in addition to malrotation, though malrotation was the most common reason for management change." — Tim (clinical) [Ep 3 · 5:47](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=347)
- "For a 3-year-old child who is eating orally, gastrostomy tube placement is not routinely indicated at the time of fundoplication." (clinical) [Ep 3 · 3:45](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=225)
- "Collis gastroplasty is not necessary for routine fundoplication with hiatal hernia repair in pediatric patients." (clinical) [Ep 3 · 2:24](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=144)
- "Pyloroplasty is not routinely performed at the time of fundoplication." (clinical) [Ep 3 · 3:00](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=180)
- "For patients who tolerate nasogastric tube feeds without vomiting, gastrostomy tube alone may be sufficient without fundoplication." (clinical) [Ep 3 · 3:00](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=180)
- "For patients who continue to vomit despite nasogastric tube feeds, fundoplication (Nissen) is indicated." (clinical) [Ep 3 · 3:00](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=180)
- "In 2013, laparoscopic approach should be the default for fundoplication rather than open approach." — Tim (opinion) [Ep 3 · 6:43](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=403)
- "For type 2 (paraesophageal) hiatal hernias in children, fundoplication and hiatal hernia repair alone is adequate without gastropexy or gastrostomy tube." (clinical) [Ep 3 · 12:45](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=765)
- "Once a paraesophageal hernia is reduced and fundoplication performed, gastropexy does not appear necessary based on available data." (clinical) [Ep 3 · 12:45](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=765)
- "In gastroschisis patients being re-operated at 6 months of age, there are often not many adhesions present, making laparoscopic approach feasible." (clinical) [Ep 3 · 15:00](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=900)
- "For gastroschisis patients requiring fundoplication, left upper quadrant initial port placement via mini cut-down is preferred over umbilical access to avoid adhesions." (clinical) [Ep 3 · 15:00](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=900)
- "In neurologically normal 6-month-old infants with reflux, there may be justification to wait longer before proceeding to fundoplication since they may still outgrow reflux." — Tim (opinion) [Ep 3 · 16:38](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=998)
- "Laparoscopic approach can be successfully attempted even in patients with previous abdominal operations, as adequate visualization can usually be achieved with patience." (clinical) [Ep 3 · 16:59](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1019)
- "For redo fundoplication after prior laparoscopic Nissen, laparoscopic approach is preferred as visualization is often better than with open technique, even in the upper abdomen." (clinical) [Ep 3 · 18:11](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1091)
- "Laparoscopic anti-reflux operations are well-tolerated by infants with cardiac anomalies." — Tim (clinical) [Ep 3 · 22:16](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1336)
- "Wrap herniation above the diaphragm is NOT more common in the open group compared to laparoscopic (contrary to what might be expected)." — Tim (clinical) [Ep 3 · 22:16](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1336)
- "Postoperative bowel obstruction rates are significantly lower with laparoscopic fundoplication compared to open approach." — Tim (clinical) [Ep 3 · 22:37](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1357)
- "Traditional rates of postoperative bowel obstruction after open fundoplication were quoted as 5-10%." (epidemiological) [Ep 3 · 22:37](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1357)
- "Current estimated rate of postoperative bowel obstruction after laparoscopic fundoplication is approximately 1-2%." (epidemiological) [Ep 3 · 22:37](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1357)
- "For laparoscopic fundoplication, ports are placed higher in the abdomen, which may contribute to even lower bowel obstruction rates than general laparoscopic surgery." — Tim (clinical) [Ep 3 · 22:52](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1372)
- "Neurologically impaired children who develop adhesive bowel obstruction after fundoplication may present late and very ill because they have a closed-loop obstruction with inability to vomit." (clinical) [Ep 3 · 23:01](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1381)
- "Nasogastric tube trial is a useful diagnostic test: if a vomiting patient does well with NG feeds, they may only need a gastrostomy tube; if they continue to vomit with NG feeds, they will need fundoplication." (clinical) [Ep 3 · 23:35](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1415)
- "Nasojejunal tube trial is even more diagnostic than nasogastric tube, as tolerance of NJ feeds strongly predicts success with fundoplication." (clinical) [Ep 3 · 23:35](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1415)
- "For infants with hypoplastic left heart status-post stage 1 repair who have documented aspiration and recurrent desaturation events that cease with NJ feeds, fundoplication is indicated." (clinical) [Ep 3 · 24:23](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1463)
- "Indications for fundoplication in cardiac patients include recurrent aspirations, apnea-bradycardia-desaturation events, or failure to thrive, not simply the presence of cardiac anomaly alone." (clinical) [Ep 3 · 24:23](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1463)
- "In cardiac patients who are failing to thrive and need gastrostomy tube, performing fundoplication at the same time prevents creating an aspiration risk with G-tube alone." — Tim (clinical) [Ep 3 · 24:53](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1493)
- "PEG tubes that stick straight out are particularly cumbersome in cardiac patients who have sternal wires and atrial leads." — Tim (clinical) [Ep 3 · 24:53](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1493)
- "PEG tubes are not very appropriate for babies in general." (opinion) [Ep 3 · 25:19](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1519)
- "Cardiologists and pulmonologists are aggressive about recommending fundoplication for children with pulmonary hypertension or cardiac anomalies who are borderline feeders." — Tim (clinical) [Ep 3 · 25:50](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1550)
- "For cardiac patients too sick for fundoplication, primary GJ tube placement is an alternative, allowing jejunal feeding in hospitalized patients." — Tim (clinical) [Ep 3 · 25:50](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1550)
- "Fundoplication alone typically improves gastric emptying in most patients, eliminating the need for routine pyloroplasty." — Tim (clinical) [Ep 3 · 26:47](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1607)
- "There is still a segment of patients with poor gastric emptying despite fundoplication who may benefit from additional interventions." — Tim (clinical) [Ep 3 · 26:47](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1607)
- "Gastric electrical stimulation can effectively stop retching in neurologically impaired children with severe gastroparesis after fundoplication, with immediate cessation of retching." (clinical) [Ep 3 · 26:56](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1616)
- "Retching after fundoplication in patients with severe gastroparesis can loosen or undo the fundoplication wrap." (clinical) [Ep 3 · 26:56](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1616)
- "In the past when performing open fundoplications, gastric emptying studies were routinely checked and pyloroplasties were performed on neurologically impaired patients." (clinical) [Ep 3 · 26:56](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1616)
- "After switching to laparoscopic fundoplication and based on data showing it helps gastric emptying, routine pyloroplasty is no longer performed." (clinical) [Ep 3 · 26:56](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1616)
- "For gastric pull-up procedures (for lye stricture or esophageal atresia), pyloroplasty is performed." (clinical) [Ep 3 · 28:12](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1692)
- "For reverse gastric tube procedures performed in the neonatal period for esophageal atresia, pyloroplasty has not been performed." (clinical) [Ep 3 · 28:36](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1716)
- "Adult thoracic surgeons performing gastric pull-ups for esophageal cancer stopped doing pyloromyotomies or pyloroplasties, and if patients had emptying trouble they performed Botox injections." — Tim (host_summary) [Ep 3 · 28:49](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1729)
- "Adult thoracic surgeons found more problems with reflux and stricture at the esophagogastric anastomosis when they performed pyloroplasty during gastric pull-up." — Tim (host_summary) [Ep 3 · 28:49](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1729)
- "Over time, even though vagus nerves are divided during gastric pull-up, the stomach will eventually empty without pyloroplasty." — Tim (host_summary) [Ep 3 · 28:49](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1729)
- "When pyloroplasty is not performed during gastric pull-up, there is a lower rate of stricture at the esophagogastric anastomosis, possibly because bile is seen in the stomach on endoscopy indicating the pylorus is functioning." — Tim (clinical) [Ep 3 · 28:49](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1729)
- "Some surgeons perform a mucosal-sparing pyloroplasty (essentially a pyloromyotomy closed transversely) rather than full-thickness pyloroplasty." (host_summary) [Ep 3 · 30:04](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1804)
- "Operative intervention for hiatal hernias is indicated in symptomatic patients with type 1 or other paraesophageal hernias." — Tim (host_summary) [Ep 3 · 30:32](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1832)
- "For asymptomatic type 1 (sliding) hiatal hernias, operative intervention is not indicated." (clinical) [Ep 3 · 31:21](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1881)
- "For asymptomatic paraesophageal hernias (types 2-4), operative intervention is indicated." (clinical) [Ep 3 · 31:21](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1881)
- "In developmentally delayed children who develop small hiatal hernias after fundoplication, if they are asymptomatic, observation is appropriate given the high operative risk." — Tim (clinical) [Ep 3 · 31:21](https://qa.library.globalcastmd.com/watch/gastroesophageal-reflux-contemporary-management-pediatric-surgery-update-428?t=1881)
- "Gastroesophageal reflux occurs in more than two-thirds of otherwise healthy infants and is discussed at 25% of all 6-month pediatric visits" — Mac Harmon (host_summary) [Ep 5 · 4:57](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=297)
- "2009 NASPGHAN and ESPGHAN guidelines state surgical approaches should be reserved for children with intractable symptoms unresponsive to medical therapy and those at risk for life-threatening complications of reflux disease" — Mac Harmon (host_summary) [Ep 5 · 5:20](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=320)
- "There is a 95% chance fundoplication will be done successfully without need for another operation" — Whit Holcomb (clinical) [Ep 5 · 7:17](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=437)
- "Fundoplication is clinically 95% successful, though literature reports much higher failure rates depending on how recurrence is assessed" (clinical) [Ep 5 · 8:11](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=491)
- "In adult literature, after about 15 years almost all fundoplications are undone" — Daniel von Allmen (host_summary) [Ep 5 · 8:43](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=523)
- "AAP guidelines note H2 antagonists or PPIs may have risk factors for pneumonia, gastroenteritis, candidemia, and NEC in preterm infants" — Mac Harmon (host_summary) [Ep 5 · 9:43](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=583)
- "Immediate morbidity and mortality of laparoscopic fundoplication, even in infants, is very low and it is a safe operation" — Daniel von Allmen (clinical) [Ep 5 · 10:15](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=615)
- "Children who wretch preoperatively have high likelihood of wretching postoperatively after fundoplication" (clinical) [Ep 5 · 6:27](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=387)
- "Meta-analysis of 400 fundoplications versus 125 gastrojejunostomy tubes showed no difference in pneumonia rate or mortality, but 29% major complications in fundo group versus lower rate in GJ group, and 70% minor complications in GJ group" — Mac Harmon (host_summary) [Ep 5 · 16:52](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1012)
- "RCT of 44 laparoscopic versus 43 open fundoplications showed recurrence of reflux was 37% in laparoscopic group and only 7% in open group, with 5.2% higher risk of recurrence in laparoscopic group" — Mac Harmon (host_summary) [Ep 5 · 18:00](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1080)
- "RCT of laparoscopic versus open fundoplication in children under age 2 (21 open, 18 laparoscopic over 7 years) showed no difference in length of stay, time to full feeds, or analgesic requirements, but laparoscopic had longer operative time and higher surgical charges" — Mac Harmon (host_summary) [Ep 5 · 18:00](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1080)
- "Long-term complications of laparotomy including bowel obstruction several years after open Nissen are underreported, with morbidity and even mortality from bowel obstruction related to laparotomy" (clinical) [Ep 5 · 19:11](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1151)
- "The laparoscopic fundoplication should be the same operation done openly, just performed laparoscopically, so results should be the same" (opinion) [Ep 5 · 20:37](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1237)
- "Neurologically impaired patients do worse than neurologically normal patients after fundoplication according to historical data" — Daniel von Allmen (host_summary) [Ep 5 · 21:20](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1280)
- "Meta-analysis showed improved outcomes following complete fundoplication compared to partial wrap, though the difference was barely significant" — Mac Harmon (host_summary) [Ep 5 · 22:00](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1320)
- "Whichever fundoplication technique (complete or partial) a surgeon does best, they should perform that technique" — Whit Holcomb (opinion) [Ep 5 · 22:42](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1362)
- "Kansas City/Birmingham prospective RCT showed aggressive esophageal mobilization had 23% to 37% incidence of transmigration over 6.5 years, while minimal mobilization increased from 3% to 12%" — Whit Holcomb (host_summary) [Ep 5 · 23:19](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1399)
- "Time to diagnosis of hiatal hernia was significantly longer in minimal mobilization group compared to maximum mobilization group" — Whit Holcomb (host_summary) [Ep 5 · 23:19](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1399)
- "There was no significant difference in reflux symptoms or medication use between minimal and maximal mobilization groups at 6.5 years" — Whit Holcomb (host_summary) [Ep 5 · 23:19](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1399)
- "Transmigration was 90% of the reasons for needing to redo fundoplications in Birmingham and Kansas City practices" — Mac Harmon (clinical) [Ep 5 · 24:07](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1447)
- "Trial of bolus NG tube feeding predicts whether infant needs fundoplication: if they do well with NG tube, perform G-tube alone; if they don't, perform Nissen" — Daniel von Allmen (clinical) [Ep 5 · 25:40](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1540)
- "Bolus gastric feeding trial is the most helpful functional test for determining need for fundoplication, more informative than pH impedance probes" — Whit Holcomb (clinical) [Ep 5 · 25:58](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1558)
- "Study showed 4% incidence of changes on upper GI prior to G-tube placement, with 80% of that 4% due to malrotation" — Mac Harmon (host_summary) [Ep 5 · 27:00](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1620)
- "There is probably a 10-15% incidence of patients needing fundoplication after initial G-tube placement" — Whit Holcomb (clinical) [Ep 5 · 29:02](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1742)
- "PPIs do not stop vomiting; they make refluxed material less acidic" — Daniel von Allmen (clinical) [Ep 5 · 16:28](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=988)
- "Eosinophilic esophagitis is becoming an issue across the board as the frequency of food allergies is skyrocketing in the pediatric population" — Greg (epidemiological) [Ep 5 · 14:58](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=898)
- "EE is less likely in infants given how early in the feeding process they are, but has been seen in very young children" — Greg (clinical) [Ep 5 · 14:15](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=855)
- "Unrecognized motility disorders can be exacerbated by fundoplication, creating a functional obstruction that makes the situation more difficult" — Greg (clinical) [Ep 5 · 14:15](https://qa.library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=855)

## Changelog
- Sep 15: 3 items added automatically
- Sep 7: Published again automatically — condition is back above threshold
- Sep 7: 2 items added automatically
- Sep 7: 1 item no longer name gastroesophageal reflux disease
- Sep 7: Unpublished automatically — folded or below threshold
- Sep 7: 3 items added automatically

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