# Gastroesophageal Reflux — GCMD Library living collection

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

Updated: n/a · 5 episodes · 37 cited statements

## Episodes
### Surgical Management
- [Gastoesophageal Reflux: Update Course 2015](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670) — video · 30:06 · [machine version](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670.md)

### Evidence & Research
- [What are risk factors for anti-reflux surgery after esophageal atresia repair?](https://origin-library.globalcastmd.com/watch/what-are-risk-factors-for-anti-reflux-surgery-after-esophageal-atresia-repair-1741) — video · [machine version](https://origin-library.globalcastmd.com/watch/what-are-risk-factors-for-anti-reflux-surgery-after-esophageal-atresia-repair-1741.md)
- [Revisión de la bibliografía: Gastrostomías y Nissen 2023](https://origin-library.globalcastmd.com/watch/revisi-n-de-la-bibliograf-a-gastrostom-as-y-nissen-2023-7567) — podcast · 17:10 · [machine version](https://origin-library.globalcastmd.com/watch/revisi-n-de-la-bibliograf-a-gastrostom-as-y-nissen-2023-7567.md)

### Case-Based Learning
- [Pyloric Stenosis with Dr. Alex Bondoc](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728) — podcast · 16:20 · [machine version](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728.md)

### Patient & Family Education
- [What is Esophageal Achalasia? An ERNICA animation for patients, parents and families](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605) — video · 4:29 · [machine version](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605.md)

## Chapters
- [0:01](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1) Case presentation: 20-day-old with severe reflux and discussion of initial management (Ep 1)
- [4:00](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=240) Pediatric guidelines for GERD and surgical indications (Ep 1)
- [6:20](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=380) Preoperative counseling and defining surgical success (Ep 1)
- [10:48](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=648) Case continuation: postoperative vomiting recurrence at 3 months (Ep 1)
- [14:58](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=898) Controversial literature: fundoplication outcomes and technique comparisons (Ep 1)
- [19:09](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1149) Laparoscopic versus open fundoplication debate (Ep 1)
- [24:07](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1447) Minimal versus maximal esophageal mobilization technique (Ep 1)
- [26:22](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1582) Decision algorithms: gastrostomy alone versus fundoplication (Ep 1)
- [0:00](https://origin-library.globalcastmd.com/watch/what-are-risk-factors-for-anti-reflux-surgery-after-esophageal-atresia-repair-1741?t=0) Introduction to French EA Registry Study (Ep 2)
- [0:52](https://origin-library.globalcastmd.com/watch/what-are-risk-factors-for-anti-reflux-surgery-after-esophageal-atresia-repair-1741?t=52) Risk Factors and Methodological Concerns (Ep 2)
- [1:46](https://origin-library.globalcastmd.com/watch/what-are-risk-factors-for-anti-reflux-surgery-after-esophageal-atresia-repair-1741?t=106) Clinical Implications and Future Directions (Ep 2)
- [0:05](https://origin-library.globalcastmd.com/watch/revisi-n-de-la-bibliograf-a-gastrostom-as-y-nissen-2023-7567?t=5) Introduction and speaker presentations (Ep 3)
- [1:15](https://origin-library.globalcastmd.com/watch/revisi-n-de-la-bibliograf-a-gastrostom-as-y-nissen-2023-7567?t=75) Gastrostomy tubes and Nissen fundoplication: 2023 literature review (Ep 3)
- [0:00](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=0) Normal esophageal anatomy and physiology (Ep 4)
- [1:30](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=90) Pathophysiology of esophageal achalasia (Ep 4)
- [2:10](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=130) Epidemiology and clinical presentation (Ep 4)
- [3:00](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=180) Diagnostic approach to esophageal achalasia (Ep 4)
- [4:00](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=240) Treatment options and follow-up care (Ep 4)
- [0:00](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=0) Introduction and Case Presentation (Ep 5)
- [3:05](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=185) Epidemiology and Risk Factors (Ep 5)
- [4:37](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=277) Physical Exam and Diagnostic Workup (Ep 5)
- [6:36](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=396) Medical Management and Stabilization (Ep 5)
- [8:07](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=487) Surgical Technique and Procedure (Ep 5)
- [13:49](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=829) Post-operative Care and Outcomes (Ep 5)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Pyloric stenosis incidence is approximately 4 to 5 in 1000 live births with heavy male preponderance. — Alex Bondoc (epidemiological) [Ep 5 · 3:05](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=185)
- 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. — Alex Bondoc (opinion) [Ep 5 · 7:34](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=454)
- 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. — Alex Bondoc (clinical) [Ep 5 · 8:40](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=520)
- Gastric suction in three positions (head down, right, left) while awake is performed before induction to prevent aspiration from the atonic stomach. — Alex Bondoc (clinical) [Ep 5 · 9:16](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=556)
- For laparoscopic pyloromyotomy, 3-millimeter instruments are used through three incisions: umbilicus, right upper quadrant, and left upper quadrant. — Alex Bondoc (clinical) [Ep 5 · 10:12](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=612)
- The 3-millimeter Maryland grasper when fully opened is 13 millimeters, so a 13mm myotomy on a 15-18mm channel will be incomplete. — Alex Bondoc (clinical) [Ep 5 · 10:57](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=657)
- Air can be insufflated down a suction catheter to look for bubbles indicating mucosal perforation. — Alex Bondoc (clinical) [Ep 5 · 12:05](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=725)
- Omentum is placed on top of the myotomy site. — Alex Bondoc (clinical) [Ep 5 · 12:20](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=740)
- Open pyloromyotomy can be performed through a periumbilical incision with tunneling up to the right upper quadrant, taking advantage of babies' stretchable skin. — Alex Bondoc (clinical) [Ep 5 · 12:27](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=747)
- Incisional hernias can occur because fascia is typically not closed on stab incisions in upper quadrants; omental hernias have been observed. — Alex Bondoc (clinical) [Ep 5 · 13:06](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=786)
- Complication rates after pyloromyotomy are equivalent or better with open approach because laparoscopic pyloromyotomy is an experience and feel operation. — Alex Bondoc (opinion) [Ep 5 · 13:23](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=803)
- Post-operative vomiting is very common and does not necessarily mean the operation did not work; the atonic stomach does not remodel immediately. — Alex Bondoc (clinical) [Ep 5 · 13:54](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=834)
- Complete intolerance of feeds lasting into days post-operatively raises concern for incomplete myotomy. — Alex Bondoc (clinical) [Ep 5 · 14:13](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=853)
- There is a 95% chance fundoplication will be done successfully without need for another operation — Whit Holcomb (clinical) [Ep 1 · 7:17](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=437)
- Fundoplication is clinically 95% successful, though literature reports much higher failure rates depending on how recurrence is assessed (clinical) [Ep 1 · 8:11](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=491)
- Immediate morbidity and mortality of laparoscopic fundoplication, even in infants, is very low and it is a safe operation — Daniel von Allmen (clinical) [Ep 1 · 10:15](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=615)
- Children who wretch preoperatively have high likelihood of wretching postoperatively after fundoplication (clinical) [Ep 1 · 6:27](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=387)
- Long-term complications of laparotomy including bowel obstruction several years after open Nissen are underreported, with morbidity and even mortality from bowel obstruction related to laparotomy (clinical) [Ep 1 · 19:11](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1151)
- The laparoscopic fundoplication should be the same operation done openly, just performed laparoscopically, so results should be the same (opinion) [Ep 1 · 20:37](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1237)
- Whichever fundoplication technique (complete or partial) a surgeon does best, they should perform that technique — Whit Holcomb (opinion) [Ep 1 · 22:42](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1362)
- Transmigration was 90% of the reasons for needing to redo fundoplications in Birmingham and Kansas City practices — Mac Harmon (clinical) [Ep 1 · 24:07](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1447)
- Trial of bolus NG tube feeding predicts whether infant needs fundoplication: if they do well with NG tube, perform G-tube alone; if they don't, perform Nissen — Daniel von Allmen (clinical) [Ep 1 · 25:40](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1540)
- Bolus gastric feeding trial is the most helpful functional test for determining need for fundoplication, more informative than pH impedance probes — Whit Holcomb (clinical) [Ep 1 · 25:58](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1558)
- There is probably a 10-15% incidence of patients needing fundoplication after initial G-tube placement — Whit Holcomb (clinical) [Ep 1 · 29:02](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1742)
- PPIs do not stop vomiting; they make refluxed material less acidic — Daniel von Allmen (clinical) [Ep 1 · 16:28](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=988)
- Eosinophilic esophagitis is becoming an issue across the board as the frequency of food allergies is skyrocketing in the pediatric population — Greg (epidemiological) [Ep 1 · 14:58](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=898)
- EE is less likely in infants given how early in the feeding process they are, but has been seen in very young children — Greg (clinical) [Ep 1 · 14:15](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=855)
- Unrecognized motility disorders can be exacerbated by fundoplication, creating a functional obstruction that makes the situation more difficult — Greg (clinical) [Ep 1 · 14:15](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=855)
- The clinical assessment is always extremely important in gastrostomy and reflux management (opinion) [Ep 3 · 1:15](https://origin-library.globalcastmd.com/watch/revisi-n-de-la-bibliograf-a-gastrostom-as-y-nissen-2023-7567?t=75)
- Complications of gastrostomy include leakage and granulomas (clinical) [Ep 3 · 3:20](https://origin-library.globalcastmd.com/watch/revisi-n-de-la-bibliograf-a-gastrostom-as-y-nissen-2023-7567?t=200)
- Laparoscopic approach is preferred for gastrostomy placement (opinion) [Ep 3 · 6:40](https://origin-library.globalcastmd.com/watch/revisi-n-de-la-bibliograf-a-gastrostom-as-y-nissen-2023-7567?t=400)
- The French study established an esophageal atresia registry including results from 38 different hospitals. — Alex Kasar (epidemiological) [Ep 2 · 0:25](https://origin-library.globalcastmd.com/watch/what-are-risk-factors-for-anti-reflux-surgery-after-esophageal-atresia-repair-1741?t=25)
- The registry is a population-based study that followed over 800 children for one year after esophageal atresia repair. — Alex Kasar (epidemiological) [Ep 2 · 0:25](https://origin-library.globalcastmd.com/watch/what-are-risk-factors-for-anti-reflux-surgery-after-esophageal-atresia-repair-1741?t=25)
- The study evaluated factors that contributed to patients having fundoplication or any anti-reflux surgery by one year of age. — Alex Kasar (clinical) [Ep 2 · 0:25](https://origin-library.globalcastmd.com/watch/what-are-risk-factors-for-anti-reflux-surgery-after-esophageal-atresia-repair-1741?t=25)
- The paper does not specify how anastomotic tension was measured or quantified. — Alex Kasar (clinical) [Ep 2 · 1:19](https://origin-library.globalcastmd.com/watch/what-are-risk-factors-for-anti-reflux-surgery-after-esophageal-atresia-repair-1741?t=79)
- Measurement of anastomotic tension is subjective and varies between surgeons. — Alex Kasar (opinion) [Ep 2 · 1:19](https://origin-library.globalcastmd.com/watch/what-are-risk-factors-for-anti-reflux-surgery-after-esophageal-atresia-repair-1741?t=79)
- The study authors mentioned they would focus on Barrett's esophagus, esophagitis, adult reflux, and other outcomes in their long-term follow-up. — Alex Kasar (clinical) [Ep 2 · 2:09](https://origin-library.globalcastmd.com/watch/what-are-risk-factors-for-anti-reflux-surgery-after-esophageal-atresia-repair-1741?t=129)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- 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. — Em Gootee summarizes what Dr. Alex Bondoc said [Ep 5 · 3:24](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=204)
- Uninsured families' babies had lower chloride and higher bicarbonate levels at presentation and longer times between diagnosis and OR. — Kim Priban summarizes what Dr. Alex Bondoc said [Ep 5 · 3:44](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=224)
- A large-scale Denmark and Holland study found pyloric stenosis is 87% heritable. — Kim Priban summarizes what Dr. Alex Bondoc said [Ep 5 · 4:13](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=253)
- Researchers have identified a molecular diagnostic marker and can trace specific genetic changes indicating risk for pyloric stenosis. — Em Gootee summarizes what Dr. Alex Bondoc said [Ep 5 · 4:25](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=265)
- Ultrasound diagnostic criteria: muscle thickness greater than 4 millimeters and pyloric channel length greater than 15 millimeters suggest pyloric stenosis. — Kim Priban summarizes what Dr. Alex Bondoc said [Ep 5 · 6:23](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=383)
- 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. — Kim Priban summarizes what Dr. Alex Bondoc said [Ep 5 · 6:46](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=406)
- Recommended fluid resuscitation: isotonic saline bolus followed by maintenance IV fluids (D5 half-normal saline with 20 mEq/L potassium chloride). — Em Gootee summarizes what Dr. Alex Bondoc said [Ep 5 · 7:04](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=424)
- Nasogastric decompression should be avoided to prevent exacerbation of metabolic alkalosis. — Kim Priban summarizes what Dr. Alex Bondoc said [Ep 5 · 7:18](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=438)
- A 2023 Journal of Pediatric Surgery study suggests antibiotic prophylaxis may be unnecessary for pyloromyotomy and may carry unnecessary long-term side effects. — Em Gootee summarizes what Dr. Alex Bondoc said [Ep 5 · 8:12](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=492)
- To assess myotomy completeness, both ends of separated muscle should move independently; resistance or connected movement indicates incomplete myotomy. — Kim Priban summarizes what Dr. Alex Bondoc said [Ep 5 · 11:49](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=709)
- A flexible feeding protocol (reducing volume if baby vomits 6 times but continuing smaller feeds and increasing as tolerated) decreases length of hospital stay. — Em Gootee summarizes what Dr. Alex Bondoc said [Ep 5 · 14:30](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=870)
- 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. — Kim Priban summarizes what Dr. Alex Bondoc said [Ep 5 · 15:08](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=908)
- Gastroesophageal reflux occurs in more than two-thirds of otherwise healthy infants and is discussed at 25% of all 6-month pediatric visits — Mac Harmon summarizing the discussion [Ep 1 · 4:57](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=297)
- 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 — Mac Harmon summarizing the discussion [Ep 1 · 5:20](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=320)
- In adult literature, after about 15 years almost all fundoplications are undone — Daniel von Allmen summarizing the discussion [Ep 1 · 8:43](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=523)
- AAP guidelines note H2 antagonists or PPIs may have risk factors for pneumonia, gastroenteritis, candidemia, and NEC in preterm infants — Mac Harmon summarizing the discussion [Ep 1 · 9:43](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=583)
- Meta-analysis of 400 fundoplications versus 125 gastrojejunostomy tubes showed no difference in pneumonia rate or mortality, but 29% major complications in fundo group versus lower rate in GJ group, and 70% minor complications in GJ group — Mac Harmon summarizing the discussion [Ep 1 · 16:52](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1012)
- RCT of 44 laparoscopic versus 43 open fundoplications showed recurrence of reflux was 37% in laparoscopic group and only 7% in open group, with 5.2% higher risk of recurrence in laparoscopic group — Mac Harmon summarizing the discussion [Ep 1 · 18:00](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1080)
- RCT of laparoscopic versus open fundoplication in children under age 2 (21 open, 18 laparoscopic over 7 years) showed no difference in length of stay, time to full feeds, or analgesic requirements, but laparoscopic had longer operative time and higher surgical charges — Mac Harmon summarizing the discussion [Ep 1 · 18:00](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1080)
- Neurologically impaired patients do worse than neurologically normal patients after fundoplication according to historical data — Daniel von Allmen summarizing the discussion [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1280)
- Meta-analysis showed improved outcomes following complete fundoplication compared to partial wrap, though the difference was barely significant — Mac Harmon summarizing the discussion [Ep 1 · 22:00](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1320)
- Kansas City/Birmingham prospective RCT showed aggressive esophageal mobilization had 23% to 37% incidence of transmigration over 6.5 years, while minimal mobilization increased from 3% to 12% — Whit Holcomb summarizing the discussion [Ep 1 · 23:19](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1399)
- Time to diagnosis of hiatal hernia was significantly longer in minimal mobilization group compared to maximum mobilization group — Whit Holcomb summarizing the discussion [Ep 1 · 23:19](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1399)
- There was no significant difference in reflux symptoms or medication use between minimal and maximal mobilization groups at 6.5 years — Whit Holcomb summarizing the discussion [Ep 1 · 23:19](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1399)
- Study showed 4% incidence of changes on upper GI prior to G-tube placement, with 80% of that 4% due to malrotation — Mac Harmon summarizing the discussion [Ep 1 · 27:00](https://origin-library.globalcastmd.com/watch/gastoesophageal-reflux-update-course-2015-670?t=1620)
- Practice guidelines for gastroesophageal reflux were published by the Society of Pediatric Nutrition in North America in March 2023 — The host summarizes what Dr. Alberto Torres said [Ep 3 · 1:15](https://origin-library.globalcastmd.com/watch/revisi-n-de-la-bibliograf-a-gastrostom-as-y-nissen-2023-7567?t=75)
- Esophageal achalasia is a rare disorder of the esophagus. — The host summarizing a resource [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=0)
- Normal esophageal motility is called peristalsis. — The host summarizing a resource [Ep 4 · 0:20](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=20)
- The cardia is a muscular valve that relaxes and opens when swallowed food reaches it, then closes to prevent stomach contents from flowing back upwards. — The host summarizing a resource [Ep 4 · 0:50](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=50)
- In esophageal achalasia, peristalsis of the esophagus is progressively lost. — The host summarizing a resource [Ep 4 · 1:30](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=90)
- In esophageal achalasia, the muscular valve does not relax properly, and food builds up in the esophagus and passes into the stomach with difficulty. — The host summarizing a resource [Ep 4 · 1:40](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=100)
- The esophagus may enlarge over time in esophageal achalasia. — The host summarizing a resource [Ep 4 · 1:55](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=115)
- Esophageal achalasia can affect people of all ages and is most commonly seen in young adults, but can also affect older adults, teenagers, and very rarely children. — The host summarizing a resource [Ep 4 · 2:05](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=125)
- The cause of esophageal achalasia is unknown. — The host summarizing a resource [Ep 4 · 2:25](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=145)
- Individuals with achalasia present with difficulties swallowing food and liquid. — The host summarizing a resource [Ep 4 · 2:30](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=150)
- Food and saliva built up in the esophagus often travels back to the mouth in achalasia. — The host summarizing a resource [Ep 4 · 2:40](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=160)
- Sometimes during breathing, saliva and/or food can enter the lungs, which is called aspiration. — The host summarizing a resource [Ep 4 · 2:50](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=170)
- Some affected individuals occasionally experience pain in their chest, back and shoulders, and/or in their neck and lower jaw. — The host summarizing a resource [Ep 4 · 3:00](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=180)
- Symptoms of achalasia often occur on an irregular basis to begin with, then eventually become more common. — The host summarizing a resource [Ep 4 · 3:15](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=195)
- Progressive symptoms of achalasia often lead to weight loss or, in children, impaired growth. — The host summarizing a resource [Ep 4 · 3:30](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=210)
- Repeated unexplained lung infections can occur in achalasia. — The host summarizing a resource [Ep 4 · 3:40](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=220)
- A diagnosis of esophageal achalasia is often suspected using a barium swallow X-ray, where the liquid is observed building up in the esophagus and sometimes the esophagus is larger than normal. — The host summarizing a resource [Ep 4 · 3:50](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=230)
- Other causes of swallowing difficulties need to be excluded by performing an endoscopy with tissue biopsies. — The host summarizing a resource [Ep 4 · 4:10](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=250)
- A manometry test needs to be performed to confirm a diagnosis of esophageal achalasia, measuring the muscle coordination of the esophagus and the relaxation abilities of the muscular valve. — The host summarizing a resource [Ep 4 · 4:25](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=265)
- Individuals with esophageal achalasia should be treated at a specialist center by a dedicated team of different professionals. — The host summarizing a resource [Ep 4 · 4:45](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=285)
- The treatment of achalasia is focused on disrupting the muscular valve's abnormal persistence to stay tight, so that food can more freely pass into the stomach. — The host summarizing a resource [Ep 4 · 5:00](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=300)
- Treatment can be done by making a cut through the valve (myotomy), which can be achieved via a surgical procedure or via endoscopy. — The host summarizing a resource [Ep 4 · 5:15](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=315)
- Alternatively, the valve can be stretched using a balloon, which is called pneumatic dilation. — The host summarizing a resource [Ep 4 · 5:30](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=330)
- Treatment options for achalasia should be discussed with the clinical team and the patient's individual circumstances should be considered. — The host summarizing a resource [Ep 4 · 5:40](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=340)
- Gastroesophageal reflux is when food and acid from the stomach flows back into the esophagus. — The host summarizing a resource [Ep 4 · 5:55](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=355)
- The risk of gastroesophageal reflux differs per treatment for achalasia, and it is necessary to discuss both the advantages and disadvantages with the clinical team. — The host summarizing a resource [Ep 4 · 4:29](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=269)
- Structured regular follow-up care is essential for individuals with esophageal achalasia and should be provided by specialist clinicians. — The host summarizing a resource [Ep 4 · 4:29](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=269)
- Follow-up endoscopies should be included as part of care for achalasia. — The host summarizing a resource [Ep 4 · 4:29](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=269)
- Identifying any complications or difficulties early is very important in achalasia management. — The host summarizing a resource [Ep 4 · 4:29](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=269)
- Peer support can be accessed through patient and family support groups for achalasia. — The host summarizing a resource [Ep 4 · 4:29](https://origin-library.globalcastmd.com/watch/what-is-esophageal-achalasia-an-ernica-animation-for-patients-parents-and-famili-7605?t=269)
- Three main perioperative factors contributed to anti-reflux surgery: anastomotic tension at the time of operation, associated malformations, and birth weight. — The host summarizing the discussion [Ep 2 · 0:52](https://origin-library.globalcastmd.com/watch/what-are-risk-factors-for-anti-reflux-surgery-after-esophageal-atresia-repair-1741?t=52)
- For any increase in Z score in birth weight, the chance that patients received an anti-reflux procedure decreased. — The host summarizing the discussion [Ep 2 · 0:52](https://origin-library.globalcastmd.com/watch/what-are-risk-factors-for-anti-reflux-surgery-after-esophageal-atresia-repair-1741?t=52)

## Changelog
- Sep 25: 1 item added automatically
- Sep 22: 4 items added automatically

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