EUPSA/ERNICA
Gastroesophageal Reflux
Everything in the library about gastroesophageal reflux — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Surgical Management
1 item
Gastoesophageal Reflux: Update Course 2015
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Dr. Mac Harmon presents on gastoesophageal reflux. His discussion includes topics onsurgical approaches to GERD, AAP GERD guidelines, fundoplication and gastrostomy versus percutaneous gastrojejunostomy, laparoscopic versus open nissen fund
video30:06 · Nov 2018
Evidence & Research
1 item
Revisión de la bibliografía: Gastrostomías y Nissen 2023
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Ya es de publico conocimiento que día a día se publican miles de artículos sobre distintas patologías y que es muy difícil seguirlos.
En este formato te traemos una forma distinta de saber que es lo más actualizado sobre un tema en parti
podcast17:10 · Nov 2023
Case-Based Learning
1 item
Pyloric Stenosis with Dr. Alex Bondoc
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In this episode, we review the symptoms, diagnosis and management of pyloric stenosis with Dr. Alex Bondoc, pediatric surgeon from Cincinnati Children's.
Host: Em Gootee, Kim Priban
Key Topics Covered:
Common Diagnoses: Explo
podcast16:20 · Jun 2024
Patient & Family Education
1 item
What is Esophageal Achalasia? An ERNICA animation for patients, parents and families
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Animation video [in English]. Target audience: Patients, parents and families. The video could also be used as an explanatory tool by healthcare professionals.
For further details about this condition, possible complications and speciali
video4:29 · Nov 2023
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Pyloric Stenosis with Dr. Alex Bondoc
Pyloric stenosis incidence is approximately 4 to 5 in 1000 live births with heavy male preponderance.
epidemiologicalAlex Bondoc3:05 ↗
A 2017 Journal of Pediatric Surgery study of 584 patients found African American infants with pyloric stenosis presented with higher bicarbonate and lower chloride levels.
host_summaryEm Gootee3:24 ↗
Uninsured families' babies had lower chloride and higher bicarbonate levels at presentation and longer times between diagnosis and OR.
host_summaryKim Pribbin3:44 ↗
A large-scale Denmark and Holland study found pyloric stenosis is 87% heritable.
host_summaryKim Pribbin4:13 ↗
Researchers have identified a molecular diagnostic marker and can trace specific genetic changes indicating risk for pyloric stenosis.
host_summaryEm Gootee4:25 ↗
Ultrasound diagnostic criteria: muscle thickness greater than 4 millimeters and pyloric channel length greater than 15 millimeters suggest pyloric stenosis.
host_summaryKim Pribbin6:23 ↗
A 2008 and 2016 Journal of Pediatric Surgery study identified specific fluid resuscitation pathways that reduced blood draws and did not delay time to surgery.
host_summaryKim Pribbin6:46 ↗
Recommended fluid resuscitation: isotonic saline bolus followed by maintenance IV fluids (D5 half-normal saline with 20 mEq/L potassium chloride).
host_summaryEm Gootee7:04 ↗
Nasogastric decompression should be avoided to prevent exacerbation of metabolic alkalosis.
host_summaryKim Pribbin7:18 ↗
Atropine is traditional medical management but has fallen out of favor because pediatric anesthetists are skilled and there is low concordance between congenital anomalies creating high anesthetic risk.
opinionAlex Bondoc7:34 ↗
A 2023 Journal of Pediatric Surgery study suggests antibiotic prophylaxis may be unnecessary for pyloromyotomy and may carry unnecessary long-term side effects.
host_summaryEm Gootee8:12 ↗
The first pyloromyotomy was performed the year before Ramstedt, who popularized it using a coffee spoon, intending pyloroplasty but performing only myotomy when the baby became unstable.
clinicalAlex Bondoc8:40 ↗
Gastric suction in three positions (head down, right, left) while awake is performed before induction to prevent aspiration from the atonic stomach.
clinicalAlex Bondoc9:16 ↗
For laparoscopic pyloromyotomy, 3-millimeter instruments are used through three incisions: umbilicus, right upper quadrant, and left upper quadrant.
clinicalAlex Bondoc10:12 ↗
The 3-millimeter Maryland grasper when fully opened is 13 millimeters, so a 13mm myotomy on a 15-18mm channel will be incomplete.
clinicalAlex Bondoc10:57 ↗
To assess myotomy completeness, both ends of separated muscle should move independently; resistance or connected movement indicates incomplete myotomy.
host_summaryKim Pribbin11:49 ↗
Air can be insufflated down a suction catheter to look for bubbles indicating mucosal perforation.
clinicalAlex Bondoc12:05 ↗
Omentum is placed on top of the myotomy site.
clinicalAlex Bondoc12:20 ↗
Open pyloromyotomy can be performed through a periumbilical incision with tunneling up to the right upper quadrant, taking advantage of babies' stretchable skin.
clinicalAlex Bondoc12:27 ↗
Incisional hernias can occur because fascia is typically not closed on stab incisions in upper quadrants; omental hernias have been observed.
clinicalAlex Bondoc13:06 ↗
Complication rates after pyloromyotomy are equivalent or better with open approach because laparoscopic pyloromyotomy is an experience and feel operation.
opinionAlex Bondoc13:23 ↗
Post-operative vomiting is very common and does not necessarily mean the operation did not work; the atonic stomach does not remodel immediately.
clinicalAlex Bondoc13:54 ↗
Complete intolerance of feeds lasting into days post-operatively raises concern for incomplete myotomy.
clinicalAlex Bondoc14:13 ↗
A flexible feeding protocol (reducing volume if baby vomits 6 times but continuing smaller feeds and increasing as tolerated) decreases length of hospital stay.
host_summaryEm Gootee14:30 ↗
Studies on adults who had pyloromyotomy as children show they do not have major issues like nausea, vomiting, reflux, or other GI problems later in life, and long-term follow-up is usually not necessary.
host_summaryKim Pribbin15:08 ↗
Gastoesophageal Reflux: Update Course 2015
Gastroesophageal reflux occurs in more than two-thirds of otherwise healthy infants and is discussed at 25% of all 6-month pediatric visits
host_summaryMac Harmon4:57 ↗
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
host_summaryMac Harmon5:20 ↗
There is a 95% chance fundoplication will be done successfully without need for another operation
clinicalWhit Holcomb7:17 ↗
Fundoplication is clinically 95% successful, though literature reports much higher failure rates depending on how recurrence is assessed
clinical8:11 ↗
In adult literature, after about 15 years almost all fundoplications are undone
host_summaryDaniel von Allmen8:43 ↗
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