Rachel Rosen
365 statements · 5 topics
Aerodigestive / ENT
· guest expert
Etiologies (Gastroschisis/NEC/Atresia/Volvulus)
· guest expert
Intestinal Rehab
· guest expert
Featured statements
You really need to scope every kid before they would get a Nissen because you don't want to wrap a kid who has allergic esophagitis or eosinophilic esophagitis, and I can't stress that enough.
quote ·
Aerodigestive / ENT
Being able to use food instead of formula has really changed our rates of needing to think about fundoplication because now everything we're putting through the gastrostomy tube is so heavy.
quote ·
Aerodigestive / ENT
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.
quote ·
Aspiration
The kids who are the most miserable post Nissen, it's the kids that were retching pre-op because they retch a lot post-op too.
quote ·
Aspiration
Proton pump inhibitors just aren't going to help in this age group where they're really refluxing non-acid reflux.
quote ·
Gastroesophageal Reflux Disease
The number one masquerader that we see in kids this age who have respiratory symptoms and vomiting is aspiration.
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Rachel's statements about Aerodigestive / ENT 109 statements
Open the Aerodigestive / ENT collection →
Pediatric Gastroesophageal Reflux Disease
Statement
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.
Open
Statement
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.
Open
Quotation
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.
Open
Quotation
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.
Open
Statement
Proton pump inhibitors are not beneficial in children under the age of 1 because they reflux non-acidic milk, not acid.
Open
Statement
Proton pump inhibitors are not beneficial in children under the age of 1 because they reflux non-acidic milk, not acid.
Open
Statement
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.
Open
Statement
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.
Open
Quotation
Proton pump inhibitors just aren't going to help in this age group where they're really refluxing non-acid reflux.
Open
Quotation
Proton pump inhibitors just aren't going to help in this age group where they're really refluxing non-acid reflux.
Open
Statement
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.
Open
Statement
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.
Open
Statement
In children under 5, the most common presentation of eosinophilic esophagitis is chronic cough; the second most common is vomiting or failure to thrive.
Open
Statement
In children under 5, the most common presentation of eosinophilic esophagitis is chronic cough; the second most common is vomiting or failure to thrive.
Open
Statement
Eosinophilic esophagitis is found in about 10% of kids under age 5 who are scoped for respiratory symptoms.
Open
Statement
Eosinophilic esophagitis is found in about 10% of kids under age 5 who are scoped for respiratory symptoms.
Open
Statement
In older kids, eosinophilic esophagitis presents with chest pain, food impactions, and dysphagia.
Open
Statement
In older kids, eosinophilic esophagitis presents with chest pain, food impactions, and dysphagia.
Open
Statement
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.
Open
Statement
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.
Open
Quotation
You really need to scope every kid before they would get a Nissen because you don't want to wrap a kid who has allergic esophagitis or eosinophilic esophagitis, and I can't stress that enough.
Open
Quotation
You really need to scope every kid before they would get a Nissen because you don't want to wrap a kid who has allergic esophagitis or eosinophilic esophagitis, and I can't stress that enough.
Open
Statement
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.
Open
Statement
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.
Open
Statement
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.
Open
Statement
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.
Open
Statement
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.
Open
Statement
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.
Open
Statement
The majority of kids will outgrow their oropharyngeal dysphagia by 3 to 4 months of age.
Open
Quotation
The majority of kids will outgrow their oropharyngeal dysphagia by 3 to 4 months of age.
Open
Quotation
The majority of kids will outgrow their oropharyngeal dysphagia by 3 to 4 months of age.
Open
Statement
The majority of kids will outgrow their oropharyngeal dysphagia by 3 to 4 months of age.
Open
Statement
In kids with oropharyngeal dysphagia in the NICU, about 75% will get the NG tube out and not need to go on to gastrostomy.
Open
Statement
In kids with oropharyngeal dysphagia in the NICU, about 75% will get the NG tube out and not need to go on to gastrostomy.
Open
Quotation
When we looked at our own data at Boston Children's and we looked at rates of hospitalization, once the 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.
Open
Statement
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.
Open
Statement
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.
Open
Quotation
When we looked at our own data at Boston Children's and we looked at rates of hospitalization, once the 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.
Open
Statement
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.
Open
Quotation
The kids who are the most miserable post Nissen, it's the kids that were retching pre-op because they retch a lot post-op too.
Open
Statement
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.
Open
Quotation
The kids who are the most miserable post Nissen, it's the kids that were retching pre-op because they retch a lot post-op too.
Open
Statement
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).
Open
Statement
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).
Open
Statement
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.
Open
Statement
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.
Open
Statement
If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term.
Open
Statement
If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term.
Open
Statement
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.
Open
Statement
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.
Open
Quotation
Being able to use food instead of formula has really changed our rates of needing to think about fundoplication because now everything we're putting through the gastrostomy tube is so heavy.
Open
Statement
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.
Open
Statement
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.
Open
Quotation
Being able to use food instead of formula has really changed our rates of needing to think about fundoplication because now everything we're putting through the gastrostomy tube is so heavy.
Open
Statement
Pyloric Botox works not only for delays in emptying but also with the sensory component that triggers retching.
Open
Statement
Pyloric Botox works not only for delays in emptying but also with the sensory component that triggers retching.
Open
Statement
Cyproheptadine (periactin) helps with gastric accommodation and can control retching in kids.
Open
Statement
Cyproheptadine (periactin) helps with gastric accommodation and can control retching in kids.
Open
Statement
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.
Open
Statement
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.
Open
Statement
A study out of Cincinnati showed that blenderized feeds are a really effective therapy for treatment of post-fundoplication retching.
Open
Statement
A study out of Cincinnati showed that blenderized feeds are a really effective therapy for treatment of post-fundoplication retching.
Open
Statement
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.
Open
Statement
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.
Open
Statement
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.
Open
Statement
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.
Open
Statement
If you wrap patients who ruminate, they continue to do this even with a wrap in place, so fundoplication does not help.
Open
Statement
If you wrap patients who ruminate, they continue to do this even with a wrap in place, so fundoplication does not help.
Open
Quotation
If you wrap these patients, what we find is they continue to do this even with a wrap in place.
Open
Quotation
If you wrap these patients, what we find is they continue to do this even with a wrap in place.
Open
Gastroesophageal Reflux Disease
Statement
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.
Open
Quotation
The number one masquerader that we see in kids this age who have respiratory symptoms and vomiting is aspiration.
Open
Statement
In children under the age of 1, proton pump inhibitors are not beneficial because these kids reflux non-acidic gastric content (milk).
Open
Quotation
When you think about what babies reflux, babies reflux milk. They're fed basically every 2 to 3 hours.
Open
Statement
Normal gastric emptying of infants takes 2 to 3 hours; acid production only starts after the 3 hour mark when the stomach is empty.
Open
Statement
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.
Open
Quotation
Last thing you want to do is push them over the edge with more respiratory symptoms by prescribing a proton pump inhibitor.
Open
Statement
In kids under the age of 5, the most common presentation of eosinophilic esophagitis is chronic cough.
Open
Statement
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.
Open
Statement
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.
Open
Quotation
I can't stress that enough. You do the initial endoscopy, you see that there's eosinophils there.
Open
Statement
In about 60 to 70% of kids with eosinophilic esophagitis, the most likely allergen is dairy.
Open
Statement
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.
Open
Statement
There are no great normal values for the number of reflux episodes in pediatric patients, making pH impedance interpretation difficult.
Open
Statement
Reflux in Dr. Rosen's opinion is rarely a cause of failure to thrive and respiratory symptoms in infants.
Open
Statement
The majority of kids with oropharyngeal dysphagia will outgrow it by 3 to 4 months of age according to a study in JPGN.
Open
Statement
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.
Open
Statement
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.
Open
Statement
Kids who wretch preoperatively will likely wretch postoperatively, and families should be counseled about this.
Open
Statement
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).
Open
Statement
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.
Open
Statement
If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term.
Open
Statement
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.
Open
Statement
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.
Open
Quotation
Being able to use food instead of formula has really changed our rates of needing to think about fundoplication.
Open
Statement
Pyloric Botox works not only for delays in emptying but also with the sensory component that triggers retching.
Open
Statement
Cyproheptadine (Periactin) helps with gastric accommodation and can control retching in children.
Open
Statement
A study from Cincinnati showed that blenderized feeds are a really effective therapy for treatment of post-fundoplication retching.
Open
Statement
Gastric stimulation may work through a sensory effect rather than purely a motility effect, as some patients improve without improvements in motility.
Open
Statement
Botox doesn't reliably improve gastric emptying but helps significantly with retching, suggesting a sensory mechanism.
Open
Statement
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.
Open
Statement
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.
Open
Statement
On esophageal motility study, rumination shows simultaneous contraction of the stomach with bolus movement up into the esophagus.
Open
Statement
If you wrap patients with rumination syndrome, they continue to ruminate even with a wrap in place.
Open
Rachel's statements about Aspiration 109 statements
Open the Aspiration collection →
Pediatric Gastroesophageal Reflux Disease
Quotation
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.
Open
Statement
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.
Open
Quotation
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.
Open
Statement
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.
Open
Statement
Proton pump inhibitors are not beneficial in children under the age of 1 because they reflux non-acidic milk, not acid.
Open
Statement
Proton pump inhibitors are not beneficial in children under the age of 1 because they reflux non-acidic milk, not acid.
Open
Statement
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.
Open
Statement
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.
Open
Quotation
Proton pump inhibitors just aren't going to help in this age group where they're really refluxing non-acid reflux.
Open
Quotation
Proton pump inhibitors just aren't going to help in this age group where they're really refluxing non-acid reflux.
Open
Statement
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.
Open
Statement
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.
Open
Statement
In children under 5, the most common presentation of eosinophilic esophagitis is chronic cough; the second most common is vomiting or failure to thrive.
Open
Statement
In children under 5, the most common presentation of eosinophilic esophagitis is chronic cough; the second most common is vomiting or failure to thrive.
Open
Statement
Eosinophilic esophagitis is found in about 10% of kids under age 5 who are scoped for respiratory symptoms.
Open
Statement
Eosinophilic esophagitis is found in about 10% of kids under age 5 who are scoped for respiratory symptoms.
Open
Statement
In older kids, eosinophilic esophagitis presents with chest pain, food impactions, and dysphagia.
Open
Statement
In older kids, eosinophilic esophagitis presents with chest pain, food impactions, and dysphagia.
Open
Quotation
You really need to scope every kid before they would get a Nissen because you don't want to wrap a kid who has allergic esophagitis or eosinophilic esophagitis, and I can't stress that enough.
Open
Statement
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.
Open
Quotation
You really need to scope every kid before they would get a Nissen because you don't want to wrap a kid who has allergic esophagitis or eosinophilic esophagitis, and I can't stress that enough.
Open
Statement
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.
Open
Statement
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.
Open
Statement
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.
Open
Statement
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.
Open
Statement
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.
Open
Statement
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.
Open
Statement
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.
Open
Statement
The majority of kids will outgrow their oropharyngeal dysphagia by 3 to 4 months of age.
Open
Quotation
The majority of kids will outgrow their oropharyngeal dysphagia by 3 to 4 months of age.
Open
Statement
The majority of kids will outgrow their oropharyngeal dysphagia by 3 to 4 months of age.
Open
Quotation
The majority of kids will outgrow their oropharyngeal dysphagia by 3 to 4 months of age.
Open
Statement
In kids with oropharyngeal dysphagia in the NICU, about 75% will get the NG tube out and not need to go on to gastrostomy.
Open
Statement
In kids with oropharyngeal dysphagia in the NICU, about 75% will get the NG tube out and not need to go on to gastrostomy.
Open
Quotation
When we looked at our own data at Boston Children's and we looked at rates of hospitalization, once the 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.
Open
Quotation
When we looked at our own data at Boston Children's and we looked at rates of hospitalization, once the 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.
Open
Statement
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.
Open
Statement
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.
Open
Quotation
The kids who are the most miserable post Nissen, it's the kids that were retching pre-op because they retch a lot post-op too.
Open
Quotation
The kids who are the most miserable post Nissen, it's the kids that were retching pre-op because they retch a lot post-op too.
Open
Statement
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.
Open
Statement
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.
Open
Statement
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).
Open
Statement
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).
Open
Statement
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.
Open
Statement
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.
Open
Statement
If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term.
Open
Statement
If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term.
Open
Statement
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.
Open
Statement
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.
Open
Statement
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.
Open
Statement
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.
Open
Quotation
Being able to use food instead of formula has really changed our rates of needing to think about fundoplication because now everything we're putting through the gastrostomy tube is so heavy.
Open
Quotation
Being able to use food instead of formula has really changed our rates of needing to think about fundoplication because now everything we're putting through the gastrostomy tube is so heavy.
Open
Statement
Pyloric Botox works not only for delays in emptying but also with the sensory component that triggers retching.
Open
Statement
Pyloric Botox works not only for delays in emptying but also with the sensory component that triggers retching.
Open
Statement
Cyproheptadine (periactin) helps with gastric accommodation and can control retching in kids.
Open
Statement
Cyproheptadine (periactin) helps with gastric accommodation and can control retching in kids.
Open
Statement
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.
Open
Statement
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.
Open
Statement
A study out of Cincinnati showed that blenderized feeds are a really effective therapy for treatment of post-fundoplication retching.
Open
Statement
A study out of Cincinnati showed that blenderized feeds are a really effective therapy for treatment of post-fundoplication retching.
Open
Statement
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.
Open
Statement
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.
Open
Statement
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.
Open
Statement
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.
Open
Statement
If you wrap patients who ruminate, they continue to do this even with a wrap in place, so fundoplication does not help.
Open
Quotation
If you wrap these patients, what we find is they continue to do this even with a wrap in place.
Open
Quotation
If you wrap these patients, what we find is they continue to do this even with a wrap in place.
Open
Statement
If you wrap patients who ruminate, they continue to do this even with a wrap in place, so fundoplication does not help.
Open
Gastroesophageal Reflux Disease
Statement
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.
Open
Quotation
The number one masquerader that we see in kids this age who have respiratory symptoms and vomiting is aspiration.
Open
Statement
In children under the age of 1, proton pump inhibitors are not beneficial because these kids reflux non-acidic gastric content (milk).
Open
Quotation
When you think about what babies reflux, babies reflux milk. They're fed basically every 2 to 3 hours.
Open
Statement
Normal gastric emptying of infants takes 2 to 3 hours; acid production only starts after the 3 hour mark when the stomach is empty.
Open
Statement
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.
Open
Quotation
Last thing you want to do is push them over the edge with more respiratory symptoms by prescribing a proton pump inhibitor.
Open
Statement
In kids under the age of 5, the most common presentation of eosinophilic esophagitis is chronic cough.
Open
Statement
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.
Open
Statement
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.
Open
Quotation
I can't stress that enough. You do the initial endoscopy, you see that there's eosinophils there.
Open
Statement
In about 60 to 70% of kids with eosinophilic esophagitis, the most likely allergen is dairy.
Open
Statement
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.
Open
Statement
There are no great normal values for the number of reflux episodes in pediatric patients, making pH impedance interpretation difficult.
Open
Statement
Reflux in Dr. Rosen's opinion is rarely a cause of failure to thrive and respiratory symptoms in infants.
Open
Statement
The majority of kids with oropharyngeal dysphagia will outgrow it by 3 to 4 months of age according to a study in JPGN.
Open
Statement
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.
Open
Statement
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.
Open
Statement
Kids who wretch preoperatively will likely wretch postoperatively, and families should be counseled about this.
Open
Statement
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).
Open
Statement
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.
Open
Statement
If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term.
Open
Statement
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.
Open
Quotation
Being able to use food instead of formula has really changed our rates of needing to think about fundoplication.
Open
Statement
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.
Open
Statement
Pyloric Botox works not only for delays in emptying but also with the sensory component that triggers retching.
Open
Statement
Cyproheptadine (Periactin) helps with gastric accommodation and can control retching in children.
Open
Statement
A study from Cincinnati showed that blenderized feeds are a really effective therapy for treatment of post-fundoplication retching.
Open
Statement
Gastric stimulation may work through a sensory effect rather than purely a motility effect, as some patients improve without improvements in motility.
Open
Statement
Botox doesn't reliably improve gastric emptying but helps significantly with retching, suggesting a sensory mechanism.
Open
Statement
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.
Open
Statement
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.
Open
Statement
On esophageal motility study, rumination shows simultaneous contraction of the stomach with bolus movement up into the esophagus.
Open
Statement
If you wrap patients with rumination syndrome, they continue to ruminate even with a wrap in place.
Open
Rachel's statements about Etiologies (Gastroschisis/NEC/Atresia/Volvulus) 37 statements
Open the Etiologies (Gastroschisis/NEC/Atresia/Volvulus) collection →
Gastroesophageal Reflux Disease
Statement
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.
Open
Quotation
The number one masquerader that we see in kids this age who have respiratory symptoms and vomiting is aspiration.
Open
Statement
In children under the age of 1, proton pump inhibitors are not beneficial because these kids reflux non-acidic gastric content (milk).
Open
Quotation
When you think about what babies reflux, babies reflux milk. They're fed basically every 2 to 3 hours.
Open
Statement
Normal gastric emptying of infants takes 2 to 3 hours; acid production only starts after the 3 hour mark when the stomach is empty.
Open
Statement
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.
Open
Quotation
Last thing you want to do is push them over the edge with more respiratory symptoms by prescribing a proton pump inhibitor.
Open
Statement
In kids under the age of 5, the most common presentation of eosinophilic esophagitis is chronic cough.
Open
Statement
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.
Open
Statement
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.
Open
Quotation
I can't stress that enough. You do the initial endoscopy, you see that there's eosinophils there.
Open
Statement
In about 60 to 70% of kids with eosinophilic esophagitis, the most likely allergen is dairy.
Open
Statement
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.
Open
Statement
There are no great normal values for the number of reflux episodes in pediatric patients, making pH impedance interpretation difficult.
Open
Statement
Reflux in Dr. Rosen's opinion is rarely a cause of failure to thrive and respiratory symptoms in infants.
Open
Statement
The majority of kids with oropharyngeal dysphagia will outgrow it by 3 to 4 months of age according to a study in JPGN.
Open
Statement
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.
Open
Statement
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.
Open
Statement
Kids who wretch preoperatively will likely wretch postoperatively, and families should be counseled about this.
Open
Statement
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).
Open
Statement
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.
Open
Statement
If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term.
Open
Statement
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.
Open
Quotation
Being able to use food instead of formula has really changed our rates of needing to think about fundoplication.
Open
Statement
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.
Open
Statement
Pyloric Botox works not only for delays in emptying but also with the sensory component that triggers retching.
Open
Statement
Cyproheptadine (Periactin) helps with gastric accommodation and can control retching in children.
Open
Statement
A study from Cincinnati showed that blenderized feeds are a really effective therapy for treatment of post-fundoplication retching.
Open
Statement
Gastric stimulation may work through a sensory effect rather than purely a motility effect, as some patients improve without improvements in motility.
Open
Statement
Botox doesn't reliably improve gastric emptying but helps significantly with retching, suggesting a sensory mechanism.
Open
Statement
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.
Open
Statement
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.
Open
Statement
On esophageal motility study, rumination shows simultaneous contraction of the stomach with bolus movement up into the esophagus.
Open
Statement
If you wrap patients with rumination syndrome, they continue to ruminate even with a wrap in place.
Open
Rachel's statements about Gastroesophageal Reflux Disease 73 statements
Open the Gastroesophageal Reflux Disease collection →
Pediatric Gastroesophageal Reflux Disease
Quotation
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.
Open
Statement
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.
Open
Statement
Proton pump inhibitors are not beneficial in children under the age of 1 because they reflux non-acidic milk, not acid.
Open
Statement
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.
Open
Quotation
Proton pump inhibitors just aren't going to help in this age group where they're really refluxing non-acid reflux.
Open
Statement
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.
Open
Statement
In children under 5, the most common presentation of eosinophilic esophagitis is chronic cough; the second most common is vomiting or failure to thrive.
Open
Statement
Eosinophilic esophagitis is found in about 10% of kids under age 5 who are scoped for respiratory symptoms.
Open
Statement
In older kids, eosinophilic esophagitis presents with chest pain, food impactions, and dysphagia.
Open
Statement
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.
Open
Quotation
You really need to scope every kid before they would get a Nissen because you don't want to wrap a kid who has allergic esophagitis or eosinophilic esophagitis, and I can't stress that enough.
Open
Statement
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.
Open
Statement
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.
Open
Statement
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.
Open
Quotation
The majority of kids will outgrow their oropharyngeal dysphagia by 3 to 4 months of age.
Open
Statement
The majority of kids will outgrow their oropharyngeal dysphagia by 3 to 4 months of age.
Open
Statement
In kids with oropharyngeal dysphagia in the NICU, about 75% will get the NG tube out and not need to go on to gastrostomy.
Open
Quotation
When we looked at our own data at Boston Children's and we looked at rates of hospitalization, once the 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.
Open
Statement
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.
Open
Quotation
The kids who are the most miserable post Nissen, it's the kids that were retching pre-op because they retch a lot post-op too.
Open
Statement
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.
Open
Statement
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).
Open
Statement
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.
Open
Statement
If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term.
Open
Statement
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.
Open
Statement
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.
Open
Quotation
Being able to use food instead of formula has really changed our rates of needing to think about fundoplication because now everything we're putting through the gastrostomy tube is so heavy.
Open
Statement
Pyloric Botox works not only for delays in emptying but also with the sensory component that triggers retching.
Open
Statement
Cyproheptadine (periactin) helps with gastric accommodation and can control retching in kids.
Open
Statement
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.
Open
Statement
A study out of Cincinnati showed that blenderized feeds are a really effective therapy for treatment of post-fundoplication retching.
Open
Statement
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.
Open
Statement
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.
Open
Statement
If you wrap patients who ruminate, they continue to do this even with a wrap in place, so fundoplication does not help.
Open
Quotation
If you wrap these patients, what we find is they continue to do this even with a wrap in place.
Open
Gastroesophageal Reflux Disease
Statement
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.
Open
Quotation
The number one masquerader that we see in kids this age who have respiratory symptoms and vomiting is aspiration.
Open
Statement
In children under the age of 1, proton pump inhibitors are not beneficial because these kids reflux non-acidic gastric content (milk).
Open
Quotation
When you think about what babies reflux, babies reflux milk. They're fed basically every 2 to 3 hours.
Open
Statement
Normal gastric emptying of infants takes 2 to 3 hours; acid production only starts after the 3 hour mark when the stomach is empty.
Open
Statement
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.
Open
Quotation
Last thing you want to do is push them over the edge with more respiratory symptoms by prescribing a proton pump inhibitor.
Open
Statement
In kids under the age of 5, the most common presentation of eosinophilic esophagitis is chronic cough.
Open
Statement
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.
Open
Statement
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.
Open
Quotation
I can't stress that enough. You do the initial endoscopy, you see that there's eosinophils there.
Open
Statement
In about 60 to 70% of kids with eosinophilic esophagitis, the most likely allergen is dairy.
Open
Statement
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.
Open
Statement
There are no great normal values for the number of reflux episodes in pediatric patients, making pH impedance interpretation difficult.
Open
Statement
Reflux in Dr. Rosen's opinion is rarely a cause of failure to thrive and respiratory symptoms in infants.
Open
Statement
The majority of kids with oropharyngeal dysphagia will outgrow it by 3 to 4 months of age according to a study in JPGN.
Open
Statement
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.
Open
Statement
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.
Open
Statement
Kids who wretch preoperatively will likely wretch postoperatively, and families should be counseled about this.
Open
Statement
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).
Open
Statement
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.
Open
Statement
If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term.
Open
Statement
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.
Open
Statement
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.
Open
Quotation
Being able to use food instead of formula has really changed our rates of needing to think about fundoplication.
Open
Statement
Pyloric Botox works not only for delays in emptying but also with the sensory component that triggers retching.
Open
Statement
Cyproheptadine (Periactin) helps with gastric accommodation and can control retching in children.
Open
Statement
A study from Cincinnati showed that blenderized feeds are a really effective therapy for treatment of post-fundoplication retching.
Open
Statement
Gastric stimulation may work through a sensory effect rather than purely a motility effect, as some patients improve without improvements in motility.
Open
Statement
Botox doesn't reliably improve gastric emptying but helps significantly with retching, suggesting a sensory mechanism.
Open
Statement
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.
Open
Statement
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.
Open
Statement
On esophageal motility study, rumination shows simultaneous contraction of the stomach with bolus movement up into the esophagus.
Open
Statement
If you wrap patients with rumination syndrome, they continue to ruminate even with a wrap in place.
Open
Rachel's statements about Intestinal Rehab 37 statements
Open the Intestinal Rehab collection →
Gastroesophageal Reflux Disease
Statement
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.
Open
Quotation
The number one masquerader that we see in kids this age who have respiratory symptoms and vomiting is aspiration.
Open
Statement
In children under the age of 1, proton pump inhibitors are not beneficial because these kids reflux non-acidic gastric content (milk).
Open
Quotation
When you think about what babies reflux, babies reflux milk. They're fed basically every 2 to 3 hours.
Open
Statement
Normal gastric emptying of infants takes 2 to 3 hours; acid production only starts after the 3 hour mark when the stomach is empty.
Open
Statement
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.
Open
Quotation
Last thing you want to do is push them over the edge with more respiratory symptoms by prescribing a proton pump inhibitor.
Open
Statement
In kids under the age of 5, the most common presentation of eosinophilic esophagitis is chronic cough.
Open
Statement
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.
Open
Statement
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.
Open
Quotation
I can't stress that enough. You do the initial endoscopy, you see that there's eosinophils there.
Open
Statement
In about 60 to 70% of kids with eosinophilic esophagitis, the most likely allergen is dairy.
Open
Statement
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.
Open
Statement
There are no great normal values for the number of reflux episodes in pediatric patients, making pH impedance interpretation difficult.
Open
Statement
Reflux in Dr. Rosen's opinion is rarely a cause of failure to thrive and respiratory symptoms in infants.
Open
Statement
The majority of kids with oropharyngeal dysphagia will outgrow it by 3 to 4 months of age according to a study in JPGN.
Open
Statement
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.
Open
Statement
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.
Open
Statement
Kids who wretch preoperatively will likely wretch postoperatively, and families should be counseled about this.
Open
Statement
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).
Open
Statement
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.
Open
Statement
If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term.
Open
Statement
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.
Open
Statement
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.
Open
Quotation
Being able to use food instead of formula has really changed our rates of needing to think about fundoplication.
Open
Statement
Pyloric Botox works not only for delays in emptying but also with the sensory component that triggers retching.
Open
Statement
Cyproheptadine (Periactin) helps with gastric accommodation and can control retching in children.
Open
Statement
A study from Cincinnati showed that blenderized feeds are a really effective therapy for treatment of post-fundoplication retching.
Open
Statement
Gastric stimulation may work through a sensory effect rather than purely a motility effect, as some patients improve without improvements in motility.
Open
Statement
Botox doesn't reliably improve gastric emptying but helps significantly with retching, suggesting a sensory mechanism.
Open
Statement
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.
Open
Statement
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.
Open
Statement
On esophageal motility study, rumination shows simultaneous contraction of the stomach with bolus movement up into the esophagus.
Open
Statement
If you wrap patients with rumination syndrome, they continue to ruminate even with a wrap in place.
Open