# Gastroesophageal Reflux Disease — GCMD Library living collection

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

Updated: n/a · 4 episodes · 77 cited statements

## Episodes
### Evidence & Research
- [Esophagogastric Dissociation for GERD in Severe Neurodisability](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563) — video · 2:49 · [machine version](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563.md)
- [Esophagogastric Dissociation for GERD in Severe Neurodisability](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962) — video · 2:49 · [machine version](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962.md)

### In-Depth Reviews
- [Pediatric Gastroesophageal Reflux Disease](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359) — podcast · 81:04 · [machine version](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359.md)
- [Gastroesophageal Reflux Disease](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289) — podcast · 81:04 · [machine version](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=0) Introduction and Guest Introductions (Ep 4)
- [2:49](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=169) Initial Workup of Infant with Vomiting and Respiratory Symptoms (Ep 4)
- [8:20](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=500) Eosinophilic Esophagitis as a Masquerader (Ep 4)
- [13:20](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=800) Role of Proton Pump Inhibitors in Infants (Ep 4)
- [20:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1200) Medical Management Strategies (Ep 4)
- [28:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=1680) NICU Premature Infant Management (Ep 4)
- [35:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2100) Diagnostic Testing: Upper GI and pH Impedance (Ep 4)
- [41:40](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=2500) Rome IV Classification and Reflux Hypersensitivity (Ep 4)
- [50:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3000) Surgical Technique: Minimal Mobilization Nissen (Ep 4)
- [60:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=3600) Post-Fundoplication Retching Management (Ep 4)
- [70:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4200) Failed Fundoplication and Redo Surgery (Ep 4)
- [75:00](https://library.globalcastmd.com/watch/gastroesophageal-reflux-disease-289?t=4500) Rumination Syndrome and Esophageal Dissociation (Ep 4)
- [0:00](https://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://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://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=500) Proton pump inhibitors in infants: ineffective and harmful (Ep 1)
- [12:30](https://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://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://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://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://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://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=2690) Duration of PPI therapy and monitoring (Ep 1)
- [50:00](https://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://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3400) Post-fundoplication retching: workup and management (Ep 1)
- [61:40](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=3700) Neurologically impaired patients and indications for fundoplication (Ep 1)
- [70:00](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=4200) Failed fundoplication: when to redo and alternative procedures (Ep 1)
- [75:20](https://library.globalcastmd.com/watch/pediatric-gastroesophageal-reflux-disease-359?t=4520) Rumination syndrome: a critical masquerader (Ep 1)
- [0:04](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=4) Introduction and Historical Context of Esophagogastric Dissociation (Ep 2)
- [0:48](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=48) Study Design and Primary Outcomes (Ep 2)
- [1:49](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=109) Statistical Considerations and Study Limitations (Ep 2)
- [0:04](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=4) Introduction and Historical Context of Esophagogastric Dissociation (Ep 3)
- [0:48](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=48) Study Design and Primary Outcomes (Ep 3)
- [1:49](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=109) Statistical Significance and Study Limitations (Ep 3)

## 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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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://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 2 · 0:14](https://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 2 · 0:24](https://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 2 · 1:01](https://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 2 · 1:13](https://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 2 · 1:13](https://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 2 · 1:21](https://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 2 · 1:23](https://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 2 · 1:23](https://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 2 · 1:23](https://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 2 · 1:39](https://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 2 · 2:03](https://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 2 · 2:12](https://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 2 · 2:15](https://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 2 · 2:26](https://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 2 · 2:39](https://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 4 · 3:23](https://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 4 · 4:18](https://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 4 · 5:26](https://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 4 · 5:45](https://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 4 · 7:21](https://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 4 · 9:27](https://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 4 · 9:53](https://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 4 · 10:54](https://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 4 · 11:57](https://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 4 · 16:28](https://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 4 · 17:48](https://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 4 · 19:18](https://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 4 · 28:21](https://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 4 · 29:37](https://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 4 · 28:42](https://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 4 · 22:38](https://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 4 · 23:17](https://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 4 · 43:42](https://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 4 · 45:31](https://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 4 · 46:40](https://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 4 · 46:43](https://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 4 · 57:23](https://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 4 · 60:49](https://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 4 · 49:02](https://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 4 · 52:39](https://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 4 · 63:11](https://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 4 · 54:19](https://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 4 · 54:26](https://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 4 · 35:28](https://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 4 · 63:42](https://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 4 · 71:44](https://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 4 · 40:54](https://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 4 · 78:40](https://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 4 · 79:13](https://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 4 · 79:31](https://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 4 · 68:04](https://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 4 · 68:18](https://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 3 · 0:14](https://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 3 · 0:24](https://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 3 · 0:48](https://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 3 · 1:01](https://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 3 · 1:13](https://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 3 · 1:21](https://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 3 · 1:23](https://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 3 · 1:29](https://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 3 · 1:39](https://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 3 · 2:03](https://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 3 · 2:12](https://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 3 · 2:16](https://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 3 · 2:24](https://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 3 · 2:26](https://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 3 · 2:39](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=159)

## Changelog
- 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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