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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
2 items
What are risk factors for anti-reflux surgery after esophageal atresia repair?
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For our latest journal club, we worked with the Chilean Society of Pediatric Surgeons to highlight articles published outside of sole pediatric surgery journals. In part two, Dr. Alex Casar discusses an article by Francois et al., looking a
video · Oct 2019
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 Gootee summarizes what Dr. Alex Bondoc said — not the host's own clinical position3:24 ↗
Uninsured families' babies had lower chloride and higher bicarbonate levels at presentation and longer times between diagnosis and OR.
Host summaryKim Priban summarizes what Dr. Alex Bondoc said — not the host's own clinical position3:44 ↗
A large-scale Denmark and Holland study found pyloric stenosis is 87% heritable.
Host summaryKim Priban summarizes what Dr. Alex Bondoc said — not the host's own clinical position4:13 ↗
Researchers have identified a molecular diagnostic marker and can trace specific genetic changes indicating risk for pyloric stenosis.
Host summaryEm Gootee summarizes what Dr. Alex Bondoc said — not the host's own clinical position4:25 ↗
Ultrasound diagnostic criteria: muscle thickness greater than 4 millimeters and pyloric channel length greater than 15 millimeters suggest pyloric stenosis.
Host summaryKim Priban summarizes what Dr. Alex Bondoc said — not the host's own clinical position6:23 ↗
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 Priban summarizes what Dr. Alex Bondoc said — not the host's own clinical position6:46 ↗
Recommended fluid resuscitation: isotonic saline bolus followed by maintenance IV fluids (D5 half-normal saline with 20 mEq/L potassium chloride).
Host summaryEm Gootee summarizes what Dr. Alex Bondoc said — not the host's own clinical position7:04 ↗
Nasogastric decompression should be avoided to prevent exacerbation of metabolic alkalosis.
Host summaryKim Priban summarizes what Dr. Alex Bondoc said — not the host's own clinical position7:18 ↗
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 Gootee summarizes what Dr. Alex Bondoc said — not the host's own clinical position8:12 ↗
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 Priban summarizes what Dr. Alex Bondoc said — not the host's own clinical position11:49 ↗
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 Gootee summarizes what Dr. Alex Bondoc said — not the host's own clinical position14:30 ↗
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 Priban summarizes what Dr. Alex Bondoc said — not the host's own clinical position15:08 ↗
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 Harmon summarizing the discussion — not the host's own clinical position4:57 ↗
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 Harmon summarizing the discussion — not the host's own clinical position5:20 ↗
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 Allmen summarizing the discussion — not the host's own clinical position8:43 ↗
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