Rachel Rosen

292 timestamped statements across 4 collections — auto-found in recorded discussions, each timestamp jumps to the exact moment.

Aerodigestive / ENT · guest expert Etiologies (Gastroschisis/NEC/Atresia/Volvulus) · guest expert Intestinal Rehab · guest expert

Featured diaries

▶ Ep 1 · 29:37
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.
quote · Aerodigestive / ENT
▶ Ep 1 · 29:37
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.
quote · Aerodigestive / ENT
▶ Ep 1 · 29:37
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.
quote · Gastroesophageal Reflux Disease
▶ Ep 1 · 29:37
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.
quote · Gastroesophageal Reflux Disease
▶ Ep 24 · 8:04
Last thing you want to do is push them over the edge with more respiratory symptoms by prescribing a proton pump inhibitor.
quote · Etiologies (Gastroschisis/NEC/Atresia/Volvulus)
▶ Ep 33 · 8:04
Last thing you want to do is push them over the edge with more respiratory symptoms by prescribing a proton pump inhibitor.
quote · Intestinal Rehab

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Aerodigestive / ENT 109 entries

Pediatric Gastroesophageal Reflux Disease

▶ Ep 1 · 3:23
quote 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. ↗
▶ Ep 1 · 3:23
quote 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. ↗
▶ Ep 1 · 3:23
clinical 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. ↗
▶ Ep 1 · 3:23
clinical 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. ↗
▶ Ep 1 · 5:26
clinical Proton pump inhibitors are not beneficial in children under the age of 1 because they reflux non-acidic milk, not acid. ↗
▶ Ep 1 · 5:26
clinical Proton pump inhibitors are not beneficial in children under the age of 1 because they reflux non-acidic milk, not acid. ↗
▶ Ep 1 · 5:39
clinical 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. ↗
▶ Ep 1 · 5:39
clinical 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. ↗
▶ Ep 1 · 5:53
quote Proton pump inhibitors just aren't going to help in this age group where they're really refluxing non-acid reflux. ↗
▶ Ep 1 · 5:53
quote Proton pump inhibitors just aren't going to help in this age group where they're really refluxing non-acid reflux. ↗
▶ Ep 1 · 7:21
epidemiological 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. ↗
▶ Ep 1 · 7:21
epidemiological 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. ↗
▶ Ep 1 · 9:41
clinical In children under 5, the most common presentation of eosinophilic esophagitis is chronic cough; the second most common is vomiting or failure to thrive. ↗
▶ Ep 1 · 9:41
clinical In children under 5, the most common presentation of eosinophilic esophagitis is chronic cough; the second most common is vomiting or failure to thrive. ↗
▶ Ep 1 · 9:53
epidemiological Eosinophilic esophagitis is found in about 10% of kids under age 5 who are scoped for respiratory symptoms. ↗
▶ Ep 1 · 9:53
epidemiological Eosinophilic esophagitis is found in about 10% of kids under age 5 who are scoped for respiratory symptoms. ↗
▶ Ep 1 · 10:08
clinical In older kids, eosinophilic esophagitis presents with chest pain, food impactions, and dysphagia. ↗
▶ Ep 1 · 10:08
clinical In older kids, eosinophilic esophagitis presents with chest pain, food impactions, and dysphagia. ↗
▶ Ep 1 · 10:54
quote 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. ↗
▶ Ep 1 · 10:54
quote 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. ↗
▶ Ep 1 · 10:54
guideline 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. ↗
▶ Ep 1 · 10:54
guideline 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. ↗
▶ Ep 1 · 12:02
epidemiological About 60 to 70% of kids with eosinophilic esophagitis are allergic to dairy. ↗
▶ Ep 1 · 12:02
epidemiological About 60 to 70% of kids with eosinophilic esophagitis are allergic to dairy. ↗
▶ Ep 1 · 16:28
clinical 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. ↗
▶ Ep 1 · 16:28
clinical 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. ↗
▶ Ep 1 · 16:28
clinical 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. ↗
▶ Ep 1 · 16:28
clinical 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. ↗
▶ Ep 1 · 17:48
clinical 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. ↗
▶ Ep 1 · 17:48
clinical 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. ↗
▶ Ep 1 · 28:21
quote The majority of kids will outgrow their oropharyngeal dysphagia by 3 to 4 months of age. ↗
▶ Ep 1 · 28:21
clinical The majority of kids will outgrow their oropharyngeal dysphagia by 3 to 4 months of age. ↗
▶ Ep 1 · 28:21
quote The majority of kids will outgrow their oropharyngeal dysphagia by 3 to 4 months of age. ↗
▶ Ep 1 · 28:21
clinical The majority of kids will outgrow their oropharyngeal dysphagia by 3 to 4 months of age. ↗
▶ Ep 1 · 28:42
epidemiological In kids with oropharyngeal dysphagia in the NICU, about 75% will get the NG tube out and not need to go on to gastrostomy. ↗
▶ Ep 1 · 28:42
epidemiological In kids with oropharyngeal dysphagia in the NICU, about 75% will get the NG tube out and not need to go on to gastrostomy. ↗
▶ Ep 1 · 29:37
quote 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. ↗
▶ Ep 1 · 29:37
epidemiological 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. ↗
▶ Ep 1 · 29:37
quote 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. ↗
▶ Ep 1 · 29:37
epidemiological 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. ↗
▶ Ep 1 · 35:28
quote 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. ↗
▶ Ep 1 · 35:28
quote 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. ↗
▶ Ep 1 · 35:28
clinical 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. ↗
▶ Ep 1 · 35:28
clinical 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. ↗
▶ Ep 1 · 40:54
guideline 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). ↗
▶ Ep 1 · 40:54
guideline 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). ↗
▶ Ep 1 · 43:42
guideline 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. ↗
▶ Ep 1 · 43:42
guideline 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. ↗
▶ Ep 1 · 45:31
clinical If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term. ↗
▶ Ep 1 · 45:31
clinical If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term. ↗
▶ Ep 1 · 49:02
clinical 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. ↗
▶ Ep 1 · 49:02
clinical 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. ↗
▶ Ep 1 · 52:39
quote 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. ↗
▶ Ep 1 · 52:39
clinical 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. ↗
▶ Ep 1 · 52:39
clinical 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. ↗
▶ Ep 1 · 52:39
quote 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. ↗
▶ Ep 1 · 54:19
clinical Pyloric Botox works not only for delays in emptying but also with the sensory component that triggers retching. ↗
▶ Ep 1 · 54:19
clinical Pyloric Botox works not only for delays in emptying but also with the sensory component that triggers retching. ↗
▶ Ep 1 · 54:26
clinical Cyproheptadine (periactin) helps with gastric accommodation and can control retching in kids. ↗
▶ Ep 1 · 54:26
clinical Cyproheptadine (periactin) helps with gastric accommodation and can control retching in kids. ↗
▶ Ep 1 · 1:02:02
clinical 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. ↗
▶ Ep 1 · 1:02:02
clinical 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. ↗
▶ Ep 1 · 1:03:07
clinical A study out of Cincinnati showed that blenderized feeds are a really effective therapy for treatment of post-fundoplication retching. ↗
▶ Ep 1 · 1:03:07
clinical A study out of Cincinnati showed that blenderized feeds are a really effective therapy for treatment of post-fundoplication retching. ↗
▶ Ep 1 · 1:11:39
clinical 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. ↗
▶ Ep 1 · 1:11:39
clinical 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. ↗
▶ Ep 1 · 1:18:58
clinical 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. ↗
▶ Ep 1 · 1:18:58
clinical 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. ↗
▶ Ep 1 · 1:19:31
clinical If you wrap patients who ruminate, they continue to do this even with a wrap in place, so fundoplication does not help. ↗
▶ Ep 1 · 1:19:31
quote If you wrap these patients, what we find is they continue to do this even with a wrap in place. ↗
▶ Ep 1 · 1:19:31
clinical If you wrap patients who ruminate, they continue to do this even with a wrap in place, so fundoplication does not help. ↗
▶ Ep 1 · 1:19:31
quote If you wrap these patients, what we find is they continue to do this even with a wrap in place. ↗

Gastroesophageal Reflux Disease

▶ Ep 8 · 3:23
clinical 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. ↗
▶ Ep 8 · 3:35
quote The number one masquerader that we see in kids this age who have respiratory symptoms and vomiting is aspiration. ↗
▶ Ep 8 · 4:18
epidemiological The peak age of reflux is between 4 and 6 months of age. ↗
▶ Ep 8 · 5:26
clinical In children under the age of 1, proton pump inhibitors are not beneficial because these kids reflux non-acidic gastric content (milk). ↗
▶ Ep 8 · 5:39
quote When you think about what babies reflux, babies reflux milk. They're fed basically every 2 to 3 hours. ↗
▶ Ep 8 · 5:45
clinical Normal gastric emptying of infants takes 2 to 3 hours; acid production only starts after the 3 hour mark when the stomach is empty. ↗
▶ Ep 8 · 7:21
clinical 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. ↗
▶ Ep 8 · 8:04
quote Last thing you want to do is push them over the edge with more respiratory symptoms by prescribing a proton pump inhibitor. ↗
▶ Ep 8 · 9:27
clinical In kids under the age of 5, the most common presentation of eosinophilic esophagitis is chronic cough. ↗
▶ Ep 8 · 9:53
epidemiological 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. ↗
▶ Ep 8 · 10:54
guideline 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. ↗
▶ Ep 8 · 11:14
quote I can't stress that enough. You do the initial endoscopy, you see that there's eosinophils there. ↗
▶ Ep 8 · 11:57
epidemiological In about 60 to 70% of kids with eosinophilic esophagitis, the most likely allergen is dairy. ↗
▶ Ep 8 · 16:28
clinical 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. ↗
▶ Ep 8 · 17:48
clinical There are no great normal values for the number of reflux episodes in pediatric patients, making pH impedance interpretation difficult. ↗
▶ Ep 8 · 19:18
opinion Reflux in Dr. Rosen's opinion is rarely a cause of failure to thrive and respiratory symptoms in infants. ↗
▶ Ep 8 · 28:06
quote Reflux doesn't cause a problem unless you can't protect your airway. ↗
▶ Ep 8 · 28:21
clinical The majority of kids with oropharyngeal dysphagia will outgrow it by 3 to 4 months of age according to a study in JPGN. ↗
▶ Ep 8 · 28:42
epidemiological 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. ↗
▶ Ep 8 · 29:37
epidemiological 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. ↗
▶ Ep 8 · 35:28
clinical Kids who wretch preoperatively will likely wretch postoperatively, and families should be counseled about this. ↗
▶ Ep 8 · 40:54
guideline 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). ↗
▶ Ep 8 · 43:42
guideline 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. ↗
▶ Ep 8 · 45:31
clinical If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term. ↗
▶ Ep 8 · 45:55
quote My bias is I'll take a PPI over a fundo any day. ↗
▶ Ep 8 · 49:02
clinical 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. ↗
▶ Ep 8 · 52:39
quote Being able to use food instead of formula has really changed our rates of needing to think about fundoplication. ↗
▶ Ep 8 · 52:39
clinical 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. ↗
▶ Ep 8 · 54:19
clinical Pyloric Botox works not only for delays in emptying but also with the sensory component that triggers retching. ↗
▶ Ep 8 · 54:26
clinical Cyproheptadine (Periactin) helps with gastric accommodation and can control retching in children. ↗
▶ Ep 8 · 1:03:11
clinical A study from Cincinnati showed that blenderized feeds are a really effective therapy for treatment of post-fundoplication retching. ↗
▶ Ep 8 · 1:08:04
opinion Gastric stimulation may work through a sensory effect rather than purely a motility effect, as some patients improve without improvements in motility. ↗
▶ Ep 8 · 1:08:18
clinical Botox doesn't reliably improve gastric emptying but helps significantly with retching, suggesting a sensory mechanism. ↗
▶ Ep 8 · 1:11:44
clinical 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. ↗
▶ Ep 8 · 1:18:40
clinical 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. ↗
▶ Ep 8 · 1:19:13
clinical On esophageal motility study, rumination shows simultaneous contraction of the stomach with bolus movement up into the esophagus. ↗
▶ Ep 8 · 1:19:31
clinical If you wrap patients with rumination syndrome, they continue to ruminate even with a wrap in place. ↗
Etiologies (Gastroschisis/NEC/Atresia/Volvulus) 37 entries

Gastroesophageal Reflux Disease

▶ Ep 24 · 3:23
clinical 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. ↗
▶ Ep 24 · 3:35
quote The number one masquerader that we see in kids this age who have respiratory symptoms and vomiting is aspiration. ↗
▶ Ep 24 · 4:18
epidemiological The peak age of reflux is between 4 and 6 months of age. ↗
▶ Ep 24 · 5:26
clinical In children under the age of 1, proton pump inhibitors are not beneficial because these kids reflux non-acidic gastric content (milk). ↗
▶ Ep 24 · 5:39
quote When you think about what babies reflux, babies reflux milk. They're fed basically every 2 to 3 hours. ↗
▶ Ep 24 · 5:45
clinical Normal gastric emptying of infants takes 2 to 3 hours; acid production only starts after the 3 hour mark when the stomach is empty. ↗
▶ Ep 24 · 7:21
clinical 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. ↗
▶ Ep 24 · 8:04
quote Last thing you want to do is push them over the edge with more respiratory symptoms by prescribing a proton pump inhibitor. ↗
▶ Ep 24 · 9:27
clinical In kids under the age of 5, the most common presentation of eosinophilic esophagitis is chronic cough. ↗
▶ Ep 24 · 9:53
epidemiological 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. ↗
▶ Ep 24 · 10:54
guideline 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. ↗
▶ Ep 24 · 11:14
quote I can't stress that enough. You do the initial endoscopy, you see that there's eosinophils there. ↗
▶ Ep 24 · 11:57
epidemiological In about 60 to 70% of kids with eosinophilic esophagitis, the most likely allergen is dairy. ↗
▶ Ep 24 · 16:28
clinical 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. ↗
▶ Ep 24 · 17:48
clinical There are no great normal values for the number of reflux episodes in pediatric patients, making pH impedance interpretation difficult. ↗
▶ Ep 24 · 19:18
opinion Reflux in Dr. Rosen's opinion is rarely a cause of failure to thrive and respiratory symptoms in infants. ↗
▶ Ep 24 · 28:06
quote Reflux doesn't cause a problem unless you can't protect your airway. ↗
▶ Ep 24 · 28:21
clinical The majority of kids with oropharyngeal dysphagia will outgrow it by 3 to 4 months of age according to a study in JPGN. ↗
▶ Ep 24 · 28:42
epidemiological 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. ↗
▶ Ep 24 · 29:37
epidemiological 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. ↗
▶ Ep 24 · 35:28
clinical Kids who wretch preoperatively will likely wretch postoperatively, and families should be counseled about this. ↗
▶ Ep 24 · 40:54
guideline 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). ↗
▶ Ep 24 · 43:42
guideline 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. ↗
▶ Ep 24 · 45:31
clinical If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term. ↗
▶ Ep 24 · 45:55
quote My bias is I'll take a PPI over a fundo any day. ↗
▶ Ep 24 · 49:02
clinical 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. ↗
▶ Ep 24 · 52:39
clinical 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. ↗
▶ Ep 24 · 52:39
quote Being able to use food instead of formula has really changed our rates of needing to think about fundoplication. ↗
▶ Ep 24 · 54:19
clinical Pyloric Botox works not only for delays in emptying but also with the sensory component that triggers retching. ↗
▶ Ep 24 · 54:26
clinical Cyproheptadine (Periactin) helps with gastric accommodation and can control retching in children. ↗
▶ Ep 24 · 1:03:11
clinical A study from Cincinnati showed that blenderized feeds are a really effective therapy for treatment of post-fundoplication retching. ↗
▶ Ep 24 · 1:08:04
opinion Gastric stimulation may work through a sensory effect rather than purely a motility effect, as some patients improve without improvements in motility. ↗
▶ Ep 24 · 1:08:18
clinical Botox doesn't reliably improve gastric emptying but helps significantly with retching, suggesting a sensory mechanism. ↗
▶ Ep 24 · 1:11:44
clinical 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. ↗
▶ Ep 24 · 1:18:40
clinical 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. ↗
▶ Ep 24 · 1:19:13
clinical On esophageal motility study, rumination shows simultaneous contraction of the stomach with bolus movement up into the esophagus. ↗
▶ Ep 24 · 1:19:31
clinical If you wrap patients with rumination syndrome, they continue to ruminate even with a wrap in place. ↗
Gastroesophageal Reflux Disease 109 entries

Pediatric Gastroesophageal Reflux Disease

▶ Ep 1 · 3:23
quote 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. ↗
▶ Ep 1 · 3:23
clinical 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. ↗
▶ Ep 1 · 3:23
clinical 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. ↗
▶ Ep 1 · 3:23
quote 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. ↗
▶ Ep 1 · 5:26
clinical Proton pump inhibitors are not beneficial in children under the age of 1 because they reflux non-acidic milk, not acid. ↗
▶ Ep 1 · 5:26
clinical Proton pump inhibitors are not beneficial in children under the age of 1 because they reflux non-acidic milk, not acid. ↗
▶ Ep 1 · 5:39
clinical 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. ↗
▶ Ep 1 · 5:39
clinical 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. ↗
▶ Ep 1 · 5:53
quote Proton pump inhibitors just aren't going to help in this age group where they're really refluxing non-acid reflux. ↗
▶ Ep 1 · 5:53
quote Proton pump inhibitors just aren't going to help in this age group where they're really refluxing non-acid reflux. ↗
▶ Ep 1 · 7:21
epidemiological 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. ↗
▶ Ep 1 · 7:21
epidemiological 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. ↗
▶ Ep 1 · 9:41
clinical In children under 5, the most common presentation of eosinophilic esophagitis is chronic cough; the second most common is vomiting or failure to thrive. ↗
▶ Ep 1 · 9:41
clinical In children under 5, the most common presentation of eosinophilic esophagitis is chronic cough; the second most common is vomiting or failure to thrive. ↗
▶ Ep 1 · 9:53
epidemiological Eosinophilic esophagitis is found in about 10% of kids under age 5 who are scoped for respiratory symptoms. ↗
▶ Ep 1 · 9:53
epidemiological Eosinophilic esophagitis is found in about 10% of kids under age 5 who are scoped for respiratory symptoms. ↗
▶ Ep 1 · 10:08
clinical In older kids, eosinophilic esophagitis presents with chest pain, food impactions, and dysphagia. ↗
▶ Ep 1 · 10:08
clinical In older kids, eosinophilic esophagitis presents with chest pain, food impactions, and dysphagia. ↗
▶ Ep 1 · 10:54
quote 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. ↗
▶ Ep 1 · 10:54
guideline 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. ↗
▶ Ep 1 · 10:54
quote 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. ↗
▶ Ep 1 · 10:54
guideline 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. ↗
▶ Ep 1 · 12:02
epidemiological About 60 to 70% of kids with eosinophilic esophagitis are allergic to dairy. ↗
▶ Ep 1 · 12:02
epidemiological About 60 to 70% of kids with eosinophilic esophagitis are allergic to dairy. ↗
▶ Ep 1 · 16:28
clinical 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. ↗
▶ Ep 1 · 16:28
clinical 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. ↗
▶ Ep 1 · 16:28
clinical 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. ↗
▶ Ep 1 · 16:28
clinical 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. ↗
▶ Ep 1 · 17:48
clinical 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. ↗
▶ Ep 1 · 17:48
clinical 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. ↗
▶ Ep 1 · 28:21
quote The majority of kids will outgrow their oropharyngeal dysphagia by 3 to 4 months of age. ↗
▶ Ep 1 · 28:21
quote The majority of kids will outgrow their oropharyngeal dysphagia by 3 to 4 months of age. ↗
▶ Ep 1 · 28:21
clinical The majority of kids will outgrow their oropharyngeal dysphagia by 3 to 4 months of age. ↗
▶ Ep 1 · 28:21
clinical The majority of kids will outgrow their oropharyngeal dysphagia by 3 to 4 months of age. ↗
▶ Ep 1 · 28:42
epidemiological In kids with oropharyngeal dysphagia in the NICU, about 75% will get the NG tube out and not need to go on to gastrostomy. ↗
▶ Ep 1 · 28:42
epidemiological In kids with oropharyngeal dysphagia in the NICU, about 75% will get the NG tube out and not need to go on to gastrostomy. ↗
▶ Ep 1 · 29:37
epidemiological 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. ↗
▶ Ep 1 · 29:37
quote 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. ↗
▶ Ep 1 · 29:37
quote 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. ↗
▶ Ep 1 · 29:37
epidemiological 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. ↗
▶ Ep 1 · 35:28
quote 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. ↗
▶ Ep 1 · 35:28
clinical 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. ↗
▶ Ep 1 · 35:28
clinical 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. ↗
▶ Ep 1 · 35:28
quote 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. ↗
▶ Ep 1 · 40:54
guideline 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). ↗
▶ Ep 1 · 40:54
guideline 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). ↗
▶ Ep 1 · 43:42
guideline 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. ↗
▶ Ep 1 · 43:42
guideline 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. ↗
▶ Ep 1 · 45:31
clinical If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term. ↗
▶ Ep 1 · 45:31
clinical If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term. ↗
▶ Ep 1 · 49:02
clinical 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. ↗
▶ Ep 1 · 49:02
clinical 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. ↗
▶ Ep 1 · 52:39
quote 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. ↗
▶ Ep 1 · 52:39
clinical 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. ↗
▶ Ep 1 · 52:39
quote 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. ↗
▶ Ep 1 · 52:39
clinical 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. ↗
▶ Ep 1 · 54:19
clinical Pyloric Botox works not only for delays in emptying but also with the sensory component that triggers retching. ↗
▶ Ep 1 · 54:19
clinical Pyloric Botox works not only for delays in emptying but also with the sensory component that triggers retching. ↗
▶ Ep 1 · 54:26
clinical Cyproheptadine (periactin) helps with gastric accommodation and can control retching in kids. ↗
▶ Ep 1 · 54:26
clinical Cyproheptadine (periactin) helps with gastric accommodation and can control retching in kids. ↗
▶ Ep 1 · 1:02:02
clinical 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. ↗
▶ Ep 1 · 1:02:02
clinical 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. ↗
▶ Ep 1 · 1:03:07
clinical A study out of Cincinnati showed that blenderized feeds are a really effective therapy for treatment of post-fundoplication retching. ↗
▶ Ep 1 · 1:03:07
clinical A study out of Cincinnati showed that blenderized feeds are a really effective therapy for treatment of post-fundoplication retching. ↗
▶ Ep 1 · 1:11:39
clinical 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. ↗
▶ Ep 1 · 1:11:39
clinical 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. ↗
▶ Ep 1 · 1:18:58
clinical 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. ↗
▶ Ep 1 · 1:18:58
clinical 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. ↗
▶ Ep 1 · 1:19:31
quote If you wrap these patients, what we find is they continue to do this even with a wrap in place. ↗
▶ Ep 1 · 1:19:31
quote If you wrap these patients, what we find is they continue to do this even with a wrap in place. ↗
▶ Ep 1 · 1:19:31
clinical If you wrap patients who ruminate, they continue to do this even with a wrap in place, so fundoplication does not help. ↗
▶ Ep 1 · 1:19:31
clinical If you wrap patients who ruminate, they continue to do this even with a wrap in place, so fundoplication does not help. ↗

Gastroesophageal Reflux Disease

▶ Ep 4 · 3:23
clinical 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. ↗
▶ Ep 4 · 3:35
quote The number one masquerader that we see in kids this age who have respiratory symptoms and vomiting is aspiration. ↗
▶ Ep 4 · 4:18
epidemiological The peak age of reflux is between 4 and 6 months of age. ↗
▶ Ep 4 · 5:26
clinical In children under the age of 1, proton pump inhibitors are not beneficial because these kids reflux non-acidic gastric content (milk). ↗
▶ Ep 4 · 5:39
quote When you think about what babies reflux, babies reflux milk. They're fed basically every 2 to 3 hours. ↗
▶ Ep 4 · 5:45
clinical Normal gastric emptying of infants takes 2 to 3 hours; acid production only starts after the 3 hour mark when the stomach is empty. ↗
▶ Ep 4 · 7:21
clinical 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. ↗
▶ Ep 4 · 8:04
quote Last thing you want to do is push them over the edge with more respiratory symptoms by prescribing a proton pump inhibitor. ↗
▶ Ep 4 · 9:27
clinical In kids under the age of 5, the most common presentation of eosinophilic esophagitis is chronic cough. ↗
▶ Ep 4 · 9:53
epidemiological 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. ↗
▶ Ep 4 · 10:54
guideline 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. ↗
▶ Ep 4 · 11:14
quote I can't stress that enough. You do the initial endoscopy, you see that there's eosinophils there. ↗
▶ Ep 4 · 11:57
epidemiological In about 60 to 70% of kids with eosinophilic esophagitis, the most likely allergen is dairy. ↗
▶ Ep 4 · 16:28
clinical 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. ↗
▶ Ep 4 · 17:48
clinical There are no great normal values for the number of reflux episodes in pediatric patients, making pH impedance interpretation difficult. ↗
▶ Ep 4 · 19:18
opinion Reflux in Dr. Rosen's opinion is rarely a cause of failure to thrive and respiratory symptoms in infants. ↗
▶ Ep 4 · 28:06
quote Reflux doesn't cause a problem unless you can't protect your airway. ↗
▶ Ep 4 · 28:21
clinical The majority of kids with oropharyngeal dysphagia will outgrow it by 3 to 4 months of age according to a study in JPGN. ↗
▶ Ep 4 · 28:42
epidemiological 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. ↗
▶ Ep 4 · 29:37
epidemiological 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. ↗
▶ Ep 4 · 35:28
clinical Kids who wretch preoperatively will likely wretch postoperatively, and families should be counseled about this. ↗
▶ Ep 4 · 40:54
guideline 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). ↗
▶ Ep 4 · 43:42
guideline 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. ↗
▶ Ep 4 · 45:31
clinical If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term. ↗
▶ Ep 4 · 45:55
quote My bias is I'll take a PPI over a fundo any day. ↗
▶ Ep 4 · 49:02
clinical 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. ↗
▶ Ep 4 · 52:39
quote Being able to use food instead of formula has really changed our rates of needing to think about fundoplication. ↗
▶ Ep 4 · 52:39
clinical 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. ↗
▶ Ep 4 · 54:19
clinical Pyloric Botox works not only for delays in emptying but also with the sensory component that triggers retching. ↗
▶ Ep 4 · 54:26
clinical Cyproheptadine (Periactin) helps with gastric accommodation and can control retching in children. ↗
▶ Ep 4 · 1:03:11
clinical A study from Cincinnati showed that blenderized feeds are a really effective therapy for treatment of post-fundoplication retching. ↗
▶ Ep 4 · 1:08:04
opinion Gastric stimulation may work through a sensory effect rather than purely a motility effect, as some patients improve without improvements in motility. ↗
▶ Ep 4 · 1:08:18
clinical Botox doesn't reliably improve gastric emptying but helps significantly with retching, suggesting a sensory mechanism. ↗
▶ Ep 4 · 1:11:44
clinical 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. ↗
▶ Ep 4 · 1:18:40
clinical 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. ↗
▶ Ep 4 · 1:19:13
clinical On esophageal motility study, rumination shows simultaneous contraction of the stomach with bolus movement up into the esophagus. ↗
▶ Ep 4 · 1:19:31
clinical If you wrap patients with rumination syndrome, they continue to ruminate even with a wrap in place. ↗
Intestinal Rehab 37 entries

Gastroesophageal Reflux Disease

▶ Ep 33 · 3:23
clinical 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. ↗
▶ Ep 33 · 3:35
quote The number one masquerader that we see in kids this age who have respiratory symptoms and vomiting is aspiration. ↗
▶ Ep 33 · 4:18
epidemiological The peak age of reflux is between 4 and 6 months of age. ↗
▶ Ep 33 · 5:26
clinical In children under the age of 1, proton pump inhibitors are not beneficial because these kids reflux non-acidic gastric content (milk). ↗
▶ Ep 33 · 5:39
quote When you think about what babies reflux, babies reflux milk. They're fed basically every 2 to 3 hours. ↗
▶ Ep 33 · 5:45
clinical Normal gastric emptying of infants takes 2 to 3 hours; acid production only starts after the 3 hour mark when the stomach is empty. ↗
▶ Ep 33 · 7:21
clinical 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. ↗
▶ Ep 33 · 8:04
quote Last thing you want to do is push them over the edge with more respiratory symptoms by prescribing a proton pump inhibitor. ↗
▶ Ep 33 · 9:27
clinical In kids under the age of 5, the most common presentation of eosinophilic esophagitis is chronic cough. ↗
▶ Ep 33 · 9:53
epidemiological 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. ↗
▶ Ep 33 · 10:54
guideline 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. ↗
▶ Ep 33 · 11:14
quote I can't stress that enough. You do the initial endoscopy, you see that there's eosinophils there. ↗
▶ Ep 33 · 11:57
epidemiological In about 60 to 70% of kids with eosinophilic esophagitis, the most likely allergen is dairy. ↗
▶ Ep 33 · 16:28
clinical 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. ↗
▶ Ep 33 · 17:48
clinical There are no great normal values for the number of reflux episodes in pediatric patients, making pH impedance interpretation difficult. ↗
▶ Ep 33 · 19:18
opinion Reflux in Dr. Rosen's opinion is rarely a cause of failure to thrive and respiratory symptoms in infants. ↗
▶ Ep 33 · 28:06
quote Reflux doesn't cause a problem unless you can't protect your airway. ↗
▶ Ep 33 · 28:21
clinical The majority of kids with oropharyngeal dysphagia will outgrow it by 3 to 4 months of age according to a study in JPGN. ↗
▶ Ep 33 · 28:42
epidemiological 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. ↗
▶ Ep 33 · 29:37
epidemiological 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. ↗
▶ Ep 33 · 35:28
clinical Kids who wretch preoperatively will likely wretch postoperatively, and families should be counseled about this. ↗
▶ Ep 33 · 40:54
guideline 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). ↗
▶ Ep 33 · 43:42
guideline 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. ↗
▶ Ep 33 · 45:31
clinical If you have reflux beyond the age of 3 or 4, you're likely to continue to have it long term. ↗
▶ Ep 33 · 45:55
quote My bias is I'll take a PPI over a fundo any day. ↗
▶ Ep 33 · 49:02
clinical 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. ↗
▶ Ep 33 · 52:39
quote Being able to use food instead of formula has really changed our rates of needing to think about fundoplication. ↗
▶ Ep 33 · 52:39
clinical 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. ↗
▶ Ep 33 · 54:19
clinical Pyloric Botox works not only for delays in emptying but also with the sensory component that triggers retching. ↗
▶ Ep 33 · 54:26
clinical Cyproheptadine (Periactin) helps with gastric accommodation and can control retching in children. ↗
▶ Ep 33 · 1:03:11
clinical A study from Cincinnati showed that blenderized feeds are a really effective therapy for treatment of post-fundoplication retching. ↗
▶ Ep 33 · 1:08:04
opinion Gastric stimulation may work through a sensory effect rather than purely a motility effect, as some patients improve without improvements in motility. ↗
▶ Ep 33 · 1:08:18
clinical Botox doesn't reliably improve gastric emptying but helps significantly with retching, suggesting a sensory mechanism. ↗
▶ Ep 33 · 1:11:44
clinical 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. ↗
▶ Ep 33 · 1:18:40
clinical 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. ↗
▶ Ep 33 · 1:19:13
clinical On esophageal motility study, rumination shows simultaneous contraction of the stomach with bolus movement up into the esophagus. ↗
▶ Ep 33 · 1:19:31
clinical If you wrap patients with rumination syndrome, they continue to ruminate even with a wrap in place. ↗