Advertisement
Pediatric GERD Procedures

Pediatric GERD Procedures

Clinicians often have difficulty diagnosing GERD and discriminating it from physiologic regurgitation, especially in the pediatric population. “Childhood GERD is diagnosed commonly by clinical evaluation and often without the use of objective measures,” explains Cabrini LaRiviere, MD, MPH. A GERD diagnosis may remain, especially in young infants, until symptoms wane as part of the natural history of regurgitation or until an objective test disproves the presence of the disease. Helpful New Data Some studies have suggested that infants with GERD are more likely than older children to undergo anti-reflux procedures. However, information is lacking on these trends and often does not control for other comorbidities that can serve as indicators for anti-reflux procedures. In JAMA Surgery, Dr. LaRiviere and colleagues published work that examined infants and children with GERD who required inpatient hospitalization and a subpopulation that progressed to anti-reflux procedures. The analysis included 141,190 children with GERD, 8.2% of whom underwent anti-reflux procedures during the 9-year study period. More than half of patients undergoing these procedures were 6 months of age or younger. Although about two-thirds of children receiving anti-reflux procedures had preoperative upper gastrointestinal tract fluoroscopy, the study found that these patients did not undergo a uniform workup. “Physiologic regurgitation is common in infancy,” says Dr. LaRiviere. “In most infants, this doesn’t lead to prolonged medication use or hospitalization. In fact, this reflux in infancy typically resolves spontaneously. The challenge is that pediatricians and surgeons must determine which cases of regurgitation represent pathologic GERD and which cases might ultimately require operative intervention. We still need a clearer understanding of the role of patient age in GERD to...
Colorectal Cancer Resections in the Aging Population

Colorectal Cancer Resections in the Aging Population

According to recent estimates, about half of all cancers and 70% of all cancer deaths occur in people aged 65 and older. Gastrointestinal cancers, especially colorectal cancer (CRC), are among the most common to afflict the elderly, with peak incidences occurring when they reach their 60s and 70s. However, while the population continues to age, clinical research trials often exclude these individuals. This raises a concern that data from these investigations may not accurately reflect the true morbidity and mortality in the elderly. “The surgical community needs to recognize the aging shift that’s occurring in the United States and prepare accordingly,” says Mehraneh D. Jafari, MD. Efforts have increased to screen more patients for CRC, but it remains the third-leading type of cancer and second-leading cause of cancer-related deaths. Surgical resection is a curative modality for CRC, but studies suggest that most patients seek treatment after they have reached their 70s. Examining Trends “Few national studies have assessed the effects of age on morbidity and mortality in CRC and analyze the latest trends in surgical resection in the elderly,” says Dr. Jafari. In JAMA Surgery, Dr. Jafari teamed with Michael J. Stamos, MD, and colleagues to publish a study that sought to address this knowledge gap. The study was unique in that it assessed trends among CRC patients undergoing surgical resection while also examining small incremental age increases and the effects on overall morbidity and mortality over the past decade. For the analysis, operative outcomes after CRC surgery were reviewed using data from the Nationwide Inpatient Sample. Patients were stratified within age groups, and postoperative complications and yearly trends...
Ebola: Are We Prepared?

Ebola: Are We Prepared?

While the government came out last week proclaiming that healthcare workers are prepared for an Enola outbreak, the majority of us do not feel this is the case. Virtually no one in the US has seen, or treated, a case of Ebola virus in the past. Now, not only are we expected to recognize patients that may be infected with this deadly virus, we need to be prepared to prevent the spread of this highly contagious pathogen if we were to encounter it. The CDC has done an excellent job passing its guidelines to ER’s and local health departments across the nation. But, these simply have not trickled down to those of us on the front lines: doctors and healthcare workers in outpatient settings, nurses, EMT’s paramedics, and all those who may be the first to encounter an Ebola patient. This represents a very significant gap in the system. There is no one to blame for this gap. Everyone is working hard to get a handle on it, but it simply is an enemy we have never seen before and are forced to develop guidelines for it as we are under attack. The CDC advises that if you have a suspect patient in your practice, place him/her in an exam room, close the door, and contact the local health department. I work evening hours. The health department closes at 5PM. I cannot keep my patient locked in the exam room until they open up again in the morning. Of course, a breach of the suggested protocols will have to be made to get this patient to the emergency room where...
Get Connected

Get Connected

Get the edge on your colleagues by receiving updates directly from the Physician’s Weekly editors in multiple ways. Sign up for our weekly e-newsletter Subscribe to our RSS Feed Like us on Facebook Check us out on Google+ Follow us on Twitter Join the conversation on...
[ HIDE/SHOW ]