Do children with acid reflux have more dental problems than other children?

You take your child to his dental appointment, expecting smiles all around and a clean bill of health. Instead, you discover that your child’s teeth are in a perilous state of decay, and your child will need thousands of dollars of dental work. You’re a good mum; you brush his teeth and feed him healthy foods. How could this happen?

The answer may be acid reflux. A study from the University of California at San Francisco found that children with reflux are six times more likely to suffer damage to the enamel than healthy children.

As children grow, their reflux medication may stop working. Many children go off their medication around age one, just when teeth are popping up. But some older children still have problems with reflux. A child may think that reflux is normal, and forget to mention it to you. Fortunately, there are steps you can take to minimise the consequences of acid reflux.


During acid reflux episodes, small amounts of stomach acid travel into your mouth and can damage the enamel (outer layer of the tooth) as well as the dentin (layer on teeth under the enamel and on the root surface of teeth). In addition, the stomach acid often irritates the lining of the oesophagus.

See the Dentist Early and Often

If your child has a history of reflux, make sure he sees the dentist as soon as he has teeth. A good paediatric dentist can spot reflux damage in its early stages and help you develop a treatment plan. Some children with severe acid reflux may need to see the dentist every three months instead of every six months. When you are dealing with acid damage, prevention is much more economical than waiting for a crisis.


Unflavoured Toothpaste


Hello, I just wanted to say a massive ” THANK YOU” for creating this wonderful product. My son was diagnosed with Sensory Processing Disorder and as such is highly sensitive to smells and tastes… I have literally tried every fruit flavoured toothpaste on the market but brushing has been an utter nightmare for 6 yrs now… That was until I came across your product whilst searching through eBay… When it arrived, he was interested to find out if it had a taste or not… And I’m pleased to say, that after 5 days, his teeth have never been as clean as they are right now!!!…. So I’m going to spread the word and hope your business grows by reputation because you have certainly made a massive difference to mine & my son’s life… I also have a daughter with Autistic Spectrum Disorder and will be trying your product on her also as she has the same issues and suffered for 17 years!!!…. So, I thank you from the bottom of my heart…… You’ve changed our lives for the better… I will never purchase any other brand than yours…

(Ebay Customer / Consumer)


Review’s Page and website.


Gastroesophageal Reflux

Gastroesophageal reflux (GER, aka acid reflux or acid regurgitation) occurs when the opening to the stomach (lower oesophagal sphincter, LES) doesn’t close properly, causing food and digestive acid to rise up the oesophagus. This stomach acid irritates and inflames the oesophagus causing heartburn pain (esophagitis).

Persistent acid reflux is considered Gastroesophageal Reflux Disease (GERD), and it can eventually lead to more serious health problems including chronic esophagitis, causing pain and trouble swallowing. When gastroesophageal reflux results in persistent vomiting the vocal cords and small airways of the lung can become irritated leading to recurrent pneumonia, and breathing problems which can be mistaken for asthma.

Paediatric patients with gastroesophageal reflux have problems with irritability, poor feeding, slow growth, and respiratory trouble. For children with oesophagal birth defects, gastroesophageal reflux is common and may contribute to the formation of oesophagal narrowing or stricture, which makes swallowing difficult.

Diagnosis of gastroesophageal reflux

If gastroesophageal reflux is suspected, additional tests may be performed to test the severity of the condition:

  • Upper gastrointestinal (GI) contrast study
  • 24-hour pH monitoring
  • Upper GI endoscopy (direct telescopic visualisation)
  • Gastric emptying studies.

The type of studies performed depend on your child’s specific symptoms and condition. It is also important to determine if the GER is caused by some other condition, including oesophagal or diaphragmatic birth defects.

Treatment of gastroesophageal reflux

Medical non-operative treatment

Initial treatment for GER is usually medical non-operative treatment. In infants, this includes upright positioning and thickened feedings with or without the addition of medicine that helps the stomach empty (Reglan®). Most infants respond to medical treatment and do not require a surgical procedure. H 2-blockers, such as cimetidine or ranitidine, also may improve the success of non-operative therapy. Proton-pump inhibitors (e.g., omeprazole, Prevacid®) have revolutionised medical therapy and are effective agents for the non-operative treatment of this disorder.


Surgical intervention may be considered if medical therapy was unsuccessful or if additional complications occur. With some oesophagal birth defects, gastroesophageal reflux is a common problem and surgical intervention is often necessary.


The goal of a fundoplication is to prevent stomach contents from returning to the oesophagus. This operation is accomplished by wrapping the upper portion of the stomach around the lower portion of the oesophagus, tightening the outlet of the oesophagus as it empties into the stomach. After a fundoplication, food and fluids can pass into the stomach but are prevented from returning to the oesophagus and causing symptoms of oesophagal reflux. A large skin incision may not be required. In most cases, a fundoplication can be performed by a paediatric surgeon using a small telescope and miniaturised instruments placed through three to four band-aid sized incisions on the abdomen.

Gastroesophageal reflux following repair of oesophagal atresia and tracheoesophageal fistula.


This study represents the experience of a tertiary care centre in the Kingdom of Saudi Arabia (KSA) on the long-term effect on the lungs of oesophagal atresia (EA) and tracheoesophageal fistula repair (TEF), and to emphasise the magnitude of gastroesophageal reflux (GER) post-EA or post-TEF repair.


A retrospective review of all patients referred to the pulmonary clinic with EA/TEF or re-operative evaluations from the period 1993-2004 at King Faisal Specialist Hospital and Research Centre, Riyadh, KSA.


Forty-one patients with confirmed EA/TEF (26 males and 15 females) were included in the study. Congenital anomalies were associated in 28 (68%). Gastroesophageal reflux developed in 39 (95%) of patients, 24 (59%) needed Nissen fundoplication. Oesophagal stricture that required more than 3 dilations developed in 16 (46%) patients, oesophagal dysmotility in 37 (90%) and hiatal hernia in 11 (27%). Pulmonary complications developed in >70% of the patients including persistent atelectasis, chronic aspiration pneumonia, asthma and chronic lung disease that required oxygen for more than one month. Tracheomalacia in 12 (29%) and bronchiectasis in 7 (17%). Eighty-eight percent of patients who were able to do pulmonary function test showed abnormal values of moderate obstructive and restrictive lung disease.


Pulmonary complications cause significant and prolonged morbidities post EA/TEF repair. Gastroesophageal reflux is a common complication after EA/TEF repair and causes significant morbidity that needs a prolonged follow-up. Patients with GER may need Nissen fundal plication to improve respiratory problems.


Heartburn remedy?

An idea to help with Heartburn and GERD?

This was sent to me by a Parent, not everything works for all but this seemed to work for others, when I looked into it, before posting it on here. Plus the feedback from a large TEF support FB group was very positive. I can’t say this will work for you or your child only you will know, but it’s something, if not just an idea from other Parents.

(gastroesophageal reflux disease)

About heartburn causes: I don’t know what caused my episode. The Internet tells me that heartburn is commonly caused by an incompetence of the lower oesophagal sphincter (LES), which is a kind of valve that connects the stomach with the oesophagus. There is a long list of possible causes of this “incompetence” (eating too much, eating wrong, smoking, hiatus hernia, etc.). About the only thing that I was able to identify with was eating shortly before bedtime, and I have adjusted my habits accordingly. So far this seems to have helped, although I sometimes feel some acidity, which seems to occur when I make long breaks between meals.

First, I started taking Maalox ( a mixture of magnesium hydroxide and aluminium hydroxide) chewable tablets. I also considered Manti, but it is 50% more expensive (in Poland at least) and the only difference is that it also contains simethicone, which helps relieve excess gas. Maalox helped neutralise the acid, providing instant relief, but I found I had to take it at least once every 2 hours. That didn’t look like a good remedy to me.

Some obscure sites recommended eating Jonagold apples for heartburn and GERD (gastroesophageal reflux disease), which is a kind of chronic heartburn. The idea is that apples contain pectin, which neutralises stomach acid, and Jonagolds have the most pectin. I could find no reputable sources recommending apples as a remedy, but I thought it was worth a try. What I found was that the apples worked well — they actually provided longer-lasting relief than Maalox.

Heartburn remedy: Ground flaxseed, also I am informed it could help with Constipation.

READ this link below to find out more on this.


Reflux Charity

Supporting Families with Children with Gastro-oesophageal Reflux and Reflux Disease


As parents and carers ourselves we know only too well how stressful and exhausting it can be living with a child with reflux (GOR) every day not just for you but for them also. We do understand the battles you face, which is why Living with Reflux charity is here to help and support you.


 Seizure ?

Sandifer’s Syndrome

What is Sandifers Syndrome?

Sandifer’s Syndrome is commonly mistaken as a seizure. Associated with gastro-oesophageal reflux disease (GORD). This syndrome has very few cases reported. It is said to occur in less than 1% of children diagnosed with GORD.

Children diagnosed with Sandifer’s Syndrome will quite often grow out of it by 18-36mths unless the child has a severe mental impairment or similar conditions, in which case the child may continue to have spasms into adolescence. Typically, Sandifer’s Syndrome is not life threatening.

The spasms may occur shortly after feeding, which can help give a clue to the diagnosis of Sandifer’s Syndrome rather than a seizure.

Signs and symptoms:

The child’s head and neck may rotate to one side and the legs and feet to the other. Commonly the child will arch their back, and stretch out. The child will look stiff and may have periods crying, less commonly they may also go very quiet.

These spasms may last for 1-3 minutes.

Click the underlined RED Wording

Sandifer syndrome, or Sandifer’s syndrome, is a rare medical condition that most often occurs in infancy or late childhood, with a peak prevalence around 1 1/2 to 3 years of age. In neurologically impaired children, however, the onset may occur as late as adolescence. This syndrome is characterised by gastrointestinal symptoms, such as gastroesophageal reflux disease (GERD) or hernias, and certain neurological signs.

The neurological features of Sandifer syndrome usually involve spasmodic torticollis, or chronic involuntary movements of the neck in right, left, up or down directions, and dystonia, in which sustained muscle contractions cause twisting and writhing movements and abnormal postures. Although this condition does not have a neurological basis, it is often misdiagnosed as epileptic seizures due to these neurological signs. The spasms associated with this syndrome may last several minutes and can occur frequently throughout the day, although they are often associated with feeding.


A small sample of what Sandifer’s Syndrome can look like. Jadon was 11 weeks olds here, some of her episodes are much worse, some much easier. She was diagnosed with Acid Reflux and Sandifer




A frequent initiating factor of Sandifer syndrome is the dysfunction of the lower oesophagus; however, in some children, a definite cause is never identified. Although the causes of the neurological features of this syndrome are not clearly understood, it is thought that this syndrome may be a defence mechanism developed in some babies to deal with the pain of acid reflux. The head and neck positions associated with this syndrome may give some relief from acid reflux discomfort. Additionally, the twisting movements and the abnormal postures may be an attempt to clear acid from the oesophagus.



Magnetic Ring Helps Reduce Reflux in Patients With GERD

Wednesday, March 22, 2017

A magnetic device that improved the function of the lower oesophagal sphincter helped to reduce patients’ exposure to oesophagal acid, improved their symptoms of gastroesophageal reflux disease (GERD), and reduced their reliance on proton-pump inhibitors, according to an industry-funded prospective study. nejmoa1205544_attach_1_ganz_oa1205544_thumb111x111

The patients were fitted with bracelet-like magnetic beads that circled their lowerStab_ra1113996_f3_6 oesophagal sphincter and closed, using magnetic attraction, to aid the sphincter in resisting abnormal opening and subsequent reflux. The beads opened with food transport or increased pressure associated with burping or vomiting. Patients’ proton-pump-inhibitor dose, a frequency of use, quality of life, and foregut symptoms were recorded when the study began and 1 week, 3 months, 6 months, and annually after their operations.

The report from top link add’s more about this


Nissen fundoplication New report (out on 31-03-1017)

Patient selection, surgical technique and follow-up for a successful laparoscopic Nissen fundoplication.


VIDEO Narrated by a World ranked Surgeon

Laparoscopic Nissen Fundoplication – Narrated – 3mm JustRight Sealer

Dr. Steve Rothenberg uses the JustRight Surgical 3mm Vessel Sealing System during a laparoscopic Nissen Fundoplication

More on Steven Rothenberg click here to read about this Surgeon, someone leading the field in thoracic surgery



Ten Questions, Parents Needs to Ask Before Fundoplication Surgery

by Susan Agrawal

The following questions are intended to help parents and doctors determine how risky a fundoplication surgery would be for a specific child. Each question discusses a condition or state that may make a fundoplication more likely to have complications.

1. Does my child have a motility problem?

Many children with reflux also have concurrent motility problems, such as delayed gastric emptying, dysmotility, or an oesophagal motility problem. If your child has a diagnosed motility problem, fundoplication surgery will not change the motility problem and usually, in fact, makes it worse. A study by top motility specialists demonstrated that almost all children with functional GI symptoms had abnormal motility after anthro duodenal manometry testing and that the group of children who had had a fundoplication surgery to relieve their symptoms continued to have the same symptoms after surgery. 1 In many cases, symptoms of a motility problem are mistaken for reflux when in fact the motility problem is the underlying cause of most symptoms. Since fundoplications make the stomach smaller, children with delayed emptying may have even slower emptying. While some surgeons perform a simultaneous pyloroplasty to deal with this problem, this second surgery has its own risks and complications. Similarly, children with oesophagal motility problems who have trouble swallowing may have even more problems after surgery since fundoplication tightens the junction between the oesophagus and stomach, worsening mobility in many children. All children with significant mobility problems should avoid a fundoplication if at all possible since complications such as retching, swallowing problems, and emptying appear to be much greater in this patient population. Motility medications and a GJ tube are far better options.

2. Have all medical treatments been tried?

Almost all studies suggest trying conservative medical treatments for reflux, including medications that reduce acid, lifestyle changes such as raising the head of the bed or thickened feeds, or medications that improve stomach emptying. Despite this recommendation, as many as 14% of patients have surgery without even seeing a GI specialist and in one study 77% of patients had not exhausted all medical treatments before surgery. 2 Failed medical management of reflux, including the failure of all PPIs to reduce acid, failure of motility medication, failure of G-tube feeds alone, and failure of lifestyle changes is a necessary prerequisite for fundoplication. Surgery should not be considered until all conservative medical treatments have been tried.

3.. Has my child had the appropriate testing to rule out other conditions that mimic reflux? Shockingly, 14-26% of patients receiving a fundoplication have never had any basic testing to confirm reflux and rule out other disorders.

3.. Testing should be performed to rule out gastroparesis, cyclic vomiting, rumination, and eosinophilic esophagitis, all of which mimic reflux but will not be helped by a fundoplication.

3.. In addition, appropriate testing for reflux, particularly a pH probe or preferably an Impedance probe, should be performed to confirm reflux. The following tests are recommended at a minimum:

Upper GI to rule out anatomical problems Upper Endoscopy with biopsies to rule out Eosinophilic Esophagitis

 Gastric Emptying Scan or preferably Antroduodenal Manometry to rule out a motility problem

 pH probe or Impedance probe to confirm severity of reflux

4. Does my child have a history of vomiting, gagging, or retching?

Cont with rest click on link



The goal of a fundoplication is to prevent stomach contents from returning to the oesophagus. This operation is an accomplished by wrapping the upper portion of the stomach around the lower portion of the oesophagus, tightening the outlet of the oesophagus as it empties into the stomach. After a fundoplication, food and fluids can pass into the stomach but are prevented from returning to the oesophagus and causing symptoms of oesophagal reflux. A large skin incision may not be required. In most cases, a fundoplication can be performed by a paediatric surgeon using a small telescope and miniaturised instruments placed through three to four band-aid sized incisions on the abdomen.

Why is fundoplication necessary?

Fundoplication is recommended for children who have complications or persistent symptoms related to gastroesophageal reflux (GER) that are not improved by medication. Symptoms of gastroesophageal reflux include vomiting, esophagitis (heartburn) gastroesophageal stricture, recurrent pneumonia, breathing problems, and inadequate growth. Before an operation is performed your child may have one or more tests confirming GER, such as a pH probe study or esophagogram.

How is a fundoplication performed?

 This animation reveals more about why and how

Fundoplication is performed in two to three hours with a two to three-day hospital stay following surgery. Postoperative, during your child’s hospitalisation, he/she will receive intravenous fluids and pain medication. As soon as your child feels well enough he/ she will be allowed to eat, drink and take pain medication by mouth (usually 1-2 days after surgery). In some patients, a gastrostomy tube is placed into the stomach to allow feedings to be administered and air to be released. Air release is called “venting”. It may be hard for your child to burp for many weeks after a fundoplication. Venting allows air to leave the stomach, which decreases bloating and keeps your child comfortable. During your child’s hospital stay, the bedside nurse will teach you how to vent, care for and use the gastrostomy tube.

In most fundoplication operations, there is very little blood loss. You child will receive blood only in the rare case of an extreme emergency. If you wish to provide a directed donation of blood, contact our office, 1-2 weeks in advance of the operation.

How long will my child remain in the hospital after the operation?

Most children are ready to go home in two to three days after the operation.


Most children are ready to go home in two to three days after the operation. Your child’s diet may be restricted for some time and they may be required to use a gastronomy tube.

Eating By Mouth

If your child is to resume his or her usual diet, it is best to start slowly. Begin with liquids, advance to soft foods, and then to a regular diet. It may take several weeks for the postoperative swelling to subside and for solid foods to pass easily into the stomach. Foods that cannot pass into the stomach will be vomited up. It is not unusual for this to occur from time to time in the first few weeks after surgery.

Gastrostomy Tube and Supplies

If your child leaves the hospital with a gastrostomy tube, a replacement tube of the same size will be sent home with you at discharge. If your child will be receiving feedings by gastrostomy, supplies will be ordered by the surgical nurse practitioner from a home care company. The home care company will ship supplies directly to your home. A nurse may come to your home, for a few visits, to help you learn to deliver feedings and take care of the gastrostomy tube. Long-term management of feedings and ordering of supplies will generally be the responsibility of your child’s gastroenterologist.

Pain Management

Prescription pain medication is not routinely required after hospital discharge. Most children only need Acetaminophen (Tylenol®) or Ibuprofen (Motrin®) once they are at home. Follow the dosage directions on the label. If your child is still uncomfortable, call our office and we may prescribe something stronger.

Care for Dressings

Gauze and clear plastic dressings, placed over the incisions, may be removed two days after surgery. Over the incision, there will be pieces of tape called Steri-strips®. On the Steri-strips®, there may be a small amount of blood. This is normal. Your child can bathe with the Steri-strips® in place. These can be removed one week after the operation. The skin surrounding the incision may be red and bruised, and the incision may be slightly swollen. This can last several weeks. There will be no visible stitches to remove because they are under the skin. The stitches will dissolve after several weeks.

In most operations, the wound is closed with dissolvable suture (stitches). These stitches are under the skin and do not have to be removed. In some children, these stitches may come through the incision about 4 weeks postoperatively. This may be associated with a little local redness and pus and it may involve an end of the incision or a larger portion. This is normal and is best treated by gently cleansing the area with soap and water and waiting. When the suture falls out or completely dissolves, the wound will heal. If your child has worsening redness, swelling pain of the incision and a fever within 2weeks of the operation, please call our office.

Healing Ridge

After the incisions are healed you will be able to feel a firm ridge just underneath. This is called a healing ridge and it is normal to find this after surgery. The healing ridge usually lasts for several months before it softens and disappears.

Bathing Restrictions

Your child may bathe or shower as soon as two days after surgery. Once your child is feeling better, before discharge or at home, he or she may bathe or shower without restriction.

Activity Restrictions

There are no specific activity restrictions following surgery. Your child can return to school as soon as he or she feels well enough.

Do I see the surgeon again after the operation?

A visit with your child’s Primary Provider and Gastroenterologist at one to two weeks after the discharge is recommended. Fundoplication may have long-term complications including gas bloat, difficulty swallowing, and unwrapping or slipping.


  • Any concerns you have about your child’s recovery
  • A temperature of 101°F or higher
  • A red incision
  • Increasing pain and tenderness at the incision
  • Any liquid coming out of the incision

Diet After Fundoplication

It will take time for your child to recover from this operation and for food to pass comfortably into his or her stomach. To make the first 3 months more comfortable, we have developed diet suggestions to help your child.

The First 2 Weeks

After the operation, it is best to offer liquids only. Your child may not be able to burp or vomit after the operation, therefore, avoid carbonated beverages or gum. These increase air in the stomach, which can be very painful.

Suggested Diet:

Liquids include water, juice, milk, milkshakes, ice cream, jello, jelly, pudding, and pureed soups; pureed baby food and yogurt anything runny

The 3rd And 4th Weeks

After surgery, it is much easier for your child to eat more textured foods but we recommend going slowly. You can begin by offering soft foods.

Suggested Diet:

Soft foods include mashed potatoes, pasta, rice and bread, fish, crackers, cereal, ground beef, cheese, and peanut butter.

The Next 2 Months

If eating goes well, your child can slowly resume his or her usual diet with some exceptions listed below.

Suggested Diet:

Your child may eat most foods but should avoid hot dogs, steak, chicken, pizza and nuts. These are foods that can get stuck in your child’s oesophagus and may not pass into the stomach. If this happens, your child may vomit the piece of food to clear the oesophagus or he or she may need to be hospitalised to remove the food. This is uncomfortable and sometimes frightening. It is best to prevent this situation, by avoiding potentially problematic foods, for the first 3 months after the operation.

Diet After Nissen Fundoplication Surgery

Very Interesting reading

This diet information is for patients who have recently had Nissen fundoplication surgery to correct reflux disease or to repair various types of hernias, such as a hiatal hernia and intrathoracic stomach. This diet may also be used for other gastrointestinal surgeries, such as Heller myotomy and repair of achalasia. The diet will help control diarrhoea, excess gas and swallowing problems, which may occur after this type of surgery.


Nissen fundoplication in children, and postoperative acid reducing

Outcome after Computer-Assisted (Robotic) Nissen Fundoplication in Children Measured as Pre- and Postoperative Acid Reducing and Asthma Medications Use. 

Last date: 25. May. 2016

Published: 2015-01-01


Gastro oesophagal reflux is common in infants and children and most of them will outgrow their symptoms by 12 to 18 months of age. Gastro oesophagal reflux disease (GERD) is pathological and can, if left untreated, result in complications such as reflux esophagitis, Barret oesophagus and oesophagal stricture. GERD may also be associated with pulmonary complications, apnea and failure to thrive. Medical treatment such as antacids and prokinetic medication is the first – line therapy and is successful in most patients. When this is insufficient, anti – reflux operations are considered. Previous studies have shown excellent results and low morbidity with fundoplication indicating that the operation should be performed early for children with GERD.

Laparoscopic fundoplication (LF) has now become the gold standard for surgical treatment of GERD in children and excellent symptomatic results have been shown. More and more paediatric centres around the world are now using robotic-assisted laparoscopy to perform a fundoplication. Since there is nothing robotic, i.e. automatic, about the system, we consider the term computer-assisted laparoscopic surgery (CALS) more appropriate. Although the computer – assisted technique is similar to that of conventional laparoscopy there are considerable differences, e.g. the use of 3D vision in CALS but, on the other hand, the lack of tactile response. Various studies have reported excellent short term results and demonstrated the safety and feasibility of computer-assisted fundoplication (CAF) but so far long – term studies are scarce.


This study demonstrates that the CAF significantly reduced the acid reflux from the stomach to the oesophagus and the use of anti – reflux medication.

To read the full report click the link below, scroll to near the bottom of page to find this full report

Watson Fundoplication

Laparoscopic Watson Fundoplication Is Effective and Durable in Children with Gastroesophageal Reflux


Stretta Procedure for GERD

What is the Stretta Procedure? Many patients worldwide suffer from gastro-esophageal reflux disease (GERD) and it’s side effects.  The Stretta Procedure is a new, non-surgical treatment for GERD that can alleviate the need for treatment with medications. With several recent studies showing that PPI’s such as omeprazole (also Prilosec, Nexium, Protonix, & Prevacid) causing an alarming rise in kidney and heart issues, patients are looking for alternative treatments that do not require the use of these potentially harmful medications. Fortunately, there is a new cutting-edge treatment available for treatment of GERD in the US known as The Stretta Procedure.

Stretta Therapy

Stretta Procedure for GERD: Successful 10 Year Follow-Up Data Presented at Digestive Disease Week–Sustained Improvement, Long-Term Efficacy. ORLANDO, Fla., May 19, 2013 /PRNewswire/ — The non-surgical employing low power and low temperature radiofrequency (RF) energy is effective in control of gastroesophageal reflux disease (GERD), and eliminates or reduces the need for medication 10 years post-procedure, according to an independent, prospective long-term assessment presented today at the Digestive Disease Week (DDW) meeting May 18-21, 2013 in Orlando, Florida.–sustained-improvement-long-term-efficacy-208047551.html


 (GERD) Report 2017

Gastroesophageal reflux disease

This statement was reviewed and approved by the Board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) on Mar 2017.

Gastroesophageal reflux disease (GERD) is a common problem that affects approximately 30-40% of the adult population with at least 20% of Americans reporting weekly symptoms. GERD accounts for 8.9 million annual outpatient visits with an estimated annual cost of 24 billion dollars. For upper gastrointestinal endoscopy alone, the cost to the health care system is estimated at $12.3 billion annually. First-line therapy for GERD includes a combination of lifestyle modifications and medical therapy, with antireflux medications accounting for approximately $7.7 billion in annual US health care costs. GERD often requires lifelong treatment and is associated with serious health risks including esophagitis, oesophagal stricture, Barrett’s, and adenocarcinoma of the oesophagus.

Unfortunately, 25% to 42% of patients with GERD do not respond to an initial 4-8 week treatment with proton pump inhibitors (PPI). In those who do respond to therapy, the effectiveness of PPI treatment decreases over time. Antireflux surgery controls acid reflux and treats an incompetent lower oesophagal sphincter while improving patient quality of life in the long-term. Thus, PPI therapy and lifestyle modifications are frequently eliminated.

For the Full report click link

Clinical Spotlight Review: Endoluminal Treatments for Gastroesophageal Reflux Disease (GERD)

Gastronomy and Tubes

Gastronomy and Tubes


Equipment/Supply Exchange Program + Resources

To connect families in need of eternal formula, pumps, tubing and other supplies with families who have items to donate.

 Individuals Seeking Products to Individuals Donating ProductsProducts available are based solely on donations.

The Program

The Equipment/Supply Exchange Program connects

Supplies vary daily based upon what’s been donated and what’s been shipped, so check back often!

The person requesting supplies must pay for shipping prior to any products being shipped from the donor, but this should be the only cost associated with the products.

Supplies are not distributed from a central warehousethey are shipped from Individual to Individual.

Products Typically Exchanged 

Our focus is on supplies and equipment related to home tube feeding and IV nutrition. Typical items include:

Enteral formula

Feeding bags


IV poles



Related supplies

We do not list prescription drugs

Procedure for Donating Supplies or Equipment

Main Page


Complete Tubefeeding: Everything you need to know about tubefeeding, tube nutrition, and blended diets

Complete Tubefeeding is the definitive guide for anyone living with or preparing to receive a feeding tube, and those who care for them. The author, happy owner of a feeding tube himself, combines the best and latest medical research with insights from his and others’ real-world tube feeding experiences. This helpful handbook provides comprehensive and compassionate coverage of all aspects of tube feeding and nutrition via tube, including: The different types of enteral feeding tubes, their placement, use and care, with loads of useful tips and tricks to make living with a feeding tube easy as can be. Tube nutrition, with sections on commercially available formulas as well as a detailed approach to a blended diet (sometimes known as a blenderized diet) — how to use real food for tube feeding while ensuring complete nutrition and stress-free management of blending. Commonly faced problems with tubefeeding, discussed at length and with solutions presented, ranging from possible medical complications to psychological and emotional issues and the impact on family life. The introduction of a feeding tube within the family can be a time of fear and isolation, and even for many a sense of helplessness. Complete Tubefeeding empowers readers with a treasure trove of targeted, practical information, presented in down-to-earth language for the tubie, parent, carer and professional alike. Those just starting out on the tube feeding journey will reap the collected wisdom of hundreds who live and thrive with feeding tubes in addition to best practices gleaned from medical science. Those seeking nutrition information and considering a switch to a blended diet will find simple but thorough explanations and handy instructions for homemade blends. Health professionals will benefit from in-depth analysis, particularly on increasingly popular blended diets. Also included are over 35 sample blend recipes (with nutritional information provided) to adapt and quickly put to use, all created with good health, ease, and enjoyment in mind. Alongside the invaluable knowledge of hundreds of tubie parents, carers, and tubies themselves, the author presents his own personal experiences and hands-on research. Eric Aadhaar O’Gorman brings his unique and readable style, the voice of a friendly, no-nonsense expert, to an all-encompassing work on this woefully under-resourced topic. Complete Tubefeeding sheds light, inspires confidence, and proves that for tube-fed people of all ages, a healthful, easy, and indeed normal life is entirely within reach. “This is a book that should be in the library of everyone who touches the lives of individuals who use tube feedings to support their physical nutritional needs.” – Suzanne Evans Morris and Marsha Dunn-Klein, authors of the Homemade Blended Formula Handbook. “This book will be a boon for ‘newby-tubies,’ seasoned tubies, impending tubies and those who care for them in any capacity. Bon appetit!” – Dr Stephanie Spencer MB BS



Then there is this, pdf means its free to download and print at home

You can click on the PDF download link there which is of most interest to us or click on this link

Writing a Protocol UK ONLY…. NHS trusts will need to write a protocol for their employees (Schools etc) to follow for giving food via a feeding tube.  It should be based on the BDAs Tool Kit for feeding BD via a tube. This can be copied to give you an idea on what your need to know regarding this. Again this is a pdf so you can print off at home.

A blended diet resource :


PLEASE TAKE NOTE of this video

Published on Jul 14, 2014

This shows a good tip of how to cope if this tube was to break, and what to do in case of an EMERGENCY, Plus don’t panic this won’t help.

This video is for informational purposes only. It does not replace medical advice. When in doubt, contact a medical professional.

Gastronomy tube placement illustrationGastrostomy tubes are feeding tubes placed through the abdomen into the stomach. Gastrostomy tubes are used to give children formula, liquids, and medicines. These tubes are placed by aPediatric Surgeon or by a Pediatric Gastroenterologist. A gastrostomy tube is placed one of two ways: 1) percutaneously and 2) surgically.

At hospital discharge, a referral will be made to have a nurse visit your home. The nurse will help you care for the gastrostomy tube and give feedings and medications and, in general, serve as a resource in your home.

Published on Jan 23, 2015

This animation reveals the placement of a percutaneous endoscopic gastrostomy – PEG, or “feeding tube” in patients who are unable to take food by mouth for an extended period of time. It demonstrates the two main surgical techniques for PEG tube placement, the “pull” method, and the “push” method.

Surgically Inserted Gastrostomy Tubes

The paediatric surgeon places a gastrostomy tube in the operating room under general anaesthesia. This operation is done through a small incision (cut) on the abdomen. The surgeon may place a temporary tube, called a Malecot®, into the gastrostomy opening. The Malecot® will be stitched to the skin and left in place for several weeks. The Malecot® allows the gastrostomy tract to heal well before a ballon type gastrostomy tube is inserted. A Malecot® tube is about twelve inches long, and most of the tube extends out of the abdomen.

After the gastrostomy tube is placed your child will remain in the hospital for observation and care. An IV (intravenous line) will be placed in the operating room before the procedure and this will be used to give fluids, antibiotics and pain medications while your child is recovering. Feedings are usually started the day after the gastronomy is placed.

(A gastrostomy is a surgical opening made in a child’s stomach to insert a feeding tube. A child may be given a gastrostomy because serious medical problems prevent him or her from eating and drinking in the usual way or from getting enough nutrients. The tube used for feeding is sometimes called a G-tube. This video discusses a variety of issues related to using a G-tube)

Changing the Malecot® To a Balloon Gastrostomy Tube

After a few weeks, the Malecot® will be removed by the surgeon or the surgical nurse and a skin level balloon gastrostomy tube will be placed. These tubes are made of silicone. They are held in the stomach by a water-filled balloon. When the nurse inserts the device, she will teach you how to take care of the tube. For more information watch the following guides:

Percutaneous Endoscopic Gastrostomy (PEG) Tube

Gastronomy Tubes - peg tube

A PEG Tube, or Percutaneous Endoscopic Gastrostomy tube, is placed by a Pediatric Gastroenterologist in the operating room. The PEG tube is inserted using a telescopic instrument, called an endoscope. The endoscope is a small tube with a light and camera on the end that lets the Gastroenterologist see into the oesophagus (food tube) and stomach. The endoscope allows the doctor to choose the best location in the stomach to place the PEG tube. Once the location is chosen, a small opening is made on the outside of abdomen into the stomach. After the opening is made, the top part of the PEG tube is pulled up out of the stomach through this opening. The top of the tube rests on the skin and the bottom part of the PEG, which is shaped like a bulb, remains inside the stomach. This bulb shape anchors the tube in the stomach and prevents it from coming out.

After the PEG tube is placed your child will be admitted to the hospital for observation and care. The hospital stay is usually three days. Prior to the procedure, an IV (intravenous line) will be placed in the operating room. This will be used to give fluids, antibiotics and pain medication, for one to two days, as your child is recovering. Feedings will be started through the PEG tube within one or two days.

The PEG tube which is made of silicone must stay in the stomach for about three months to allow the tract (hole) to heal between the abdomen and the stomach. The tract must be well healed so it is safe for the gastrostomy tube to be changed.

I Have added this Video to just give you the Parent an idea and a few things on feeding via a tube. My own daughter is tube feed, I found this video very helpful

Taking Care of Your Child’s Gastrostomy Tube (G-Tube). Tara Spruill, RN, BSN – Nemours Children’s Clinic, Jacksonville discusses gastrostomy tube or g-tube education.


If your child requires continuous feeding with the gastrostomy tube, a pump and supplies will be ordered by the GI or surgical nurse from a home care supply company. The equipment and supplies will be delivered to your home or to the hospital before your child is discharged. You will be taught to use the pump by a representative from the home care company or home nursing agency, as pumps differ from hospital to home. Feeding bags, replacement gastrostomy tubes, extension sets, syringes, gauze, tape and formula will be ordered for your child by the GI or surgical nurse.

General Feedings Guidelines

Give feedings and medications as directed by your nurse or doctor. Flush the gastrostomy tube with 10-15cc’s of warm water after every feeding or medication. This prevents clogging and keeps the tube as clean as possible. If you are giving continuous drip feeding into a PEG tube you may want to tape connections to prevent disconnection of the extension set from the tube and spillage of feedings. If you are using a balloon gastrostomy, such as an AMT mini-one tube, check the volume of water in the balloon every week and refill as necessary to maintain the amount of water prescribed by your child’s doctor or nurse (Do not perform this until at least 2 months after the tube was initially placed).

This video will educate families on how to properly care for a pediatric gastrostomy tube. This is just to give you the Parents an idea on how or what you need to do.

What if the tube comes out before the gastrostomy tract has healed?

It rarely happens with a PEG tube and sometimes happens with the Malecot® or balloon gastrostomy tubes. If the tube becomes accidentally dislodged call your child’s doctor

If you do not speak to a doctor or nurse after thirty (30) minutes take your child and gastrostomy supplies to the nearest emergency room for tube reinsertion. A tube will be placed into the gastrostomy tract to prevent closure and the need for another operation. If the emergency room doctors and nurses have questions, they can call the paediatric gastroenterologist, or surgeon who placed the tube.

If you do not have a replacement gastrostomy tube to take with you, a FOLEY® catheter of the same size or smaller can be inserted as a replacement tube. Often, a special x-ray called a “gastrostomy tube dye study” will need to be taken to make sure the newly placed tube is in the stomach. A FOLEY® catheter can be used for feeding and stomach decompression at home. Call your GI or surgical doctor or nurse if your child required a visit to the emergency room for care of his or her gastrostomy tube.

What should I do about the following problems?

Redness around the site

The skin may be slightly pink after initial insertion. You should see a decrease in this pink colour over time. If the skin becomes tender, warm or red, call your child’s doctor or nurse.


Drainage that dries on the skin is called crusting. Crusting and drainage are common around gastrostomy tubes. You can remove crusting and drainage with warm water.


If tube gets bumped or is rubbed, there may be a small amount of bleeding from around the tube. Apply pressure should stop the bleeding for up to ten minutes. If the bleeding does not stop, call your child’s doctor or nurse. Blood coming through the tube is not normal. If this happens to call your child’s doctor or go to the nearest emergency room.

Granulation Tissue

Granulation tissue appears in most children at some time after the gastrostomy tube is placed. This tissue is common and not dangerous. It grows directly around the gastrostomy hole and looks raised, red and may ooze fluid or bleed easily. Granulation tissue should be treated when it first appears. This can be done in the office by your child’s nurse or doctor. A special ointment or cream will be prescribed to apply to the granulation tissue (not the surrounding skin) up to four times a day until the granulation tissue goes away.


If your child has a fever, call your child’s paediatrician.

Vomiting and/or diarrhoea

If your child has vomiting and/or diarrhoea, call your child’s paediatrician and the paediatric GI or surgical nurse or doctor for advice.

Homecare for Surgically Inserted Tubes

Skin Care With a Surgically Inserted Tube

Cleanse the area around the GT with water daily.After cleaning the skin around the gastrostomy tube dry well. If there is a Malecot® in place, make sure it is taped securely in place, to prevent movement.

AMT Mini One Gastrostomy Feeding Extension Sets

When your child has an AMT mini-one skin level button in place you will be using feeding extension sets. A feeding extension set is a special tube that connects to the gastrostomy tube and allows formula, liquids and medicines to be given into the stomach. There are two types of sets available for use with an AMT mini-one skin level tube. These are a 1) bolus set and a 2) right angle set. The bolus set is used for feedings given by gravity through a syringe. The right-angle set is used for slow or continuous feedings, given by a pump. Either tube can serve as a decompression tube to drain air or liquid from the stomach. The decompression tube is used if a child has too much gas (which can’t be burped up) or if the child is very uncomfortable and appears to have a bloated or full abdomen. Any AMT mini-one extension set fits any size AMT or MIC-KEY® gastrostomy tube.

Routine Changing Of Balloon Gastrostomy Tubes

The gastrostomy tube will need to be replaced when there is a malfunction, a poor fit or when it has been in for several months. Most parents are taught, in the hospital or office, how to change the gastrostomy tube and are comfortable changing the tube on their own. However, you can bring your child to the office or, in many cases, a home care nurse can be sent to your home to help you change the tube. A spare gastrostomy tube of the same size should be with your child at all times in case the balloon ruptures and replacement is required.

It is important to know the size of your child’s gastrostomy tube. It is printed in black letters on top of the gastrostomy tube. We recommend that you write down the size of your child’s tube on this document or some place where you can find it when needed. This will help you when reordering supplies and talking with your child’s doctors and nurses.–procedures/gastrostomy-tubes.aspx

Homecare for Percutaneous Endoscopic Gastrostomy (PEG) Tube

Skin Care With the PEG Tube

Cleanse the area around the GT with water for the first two days after placement. After this, daily bathing with soap and water is all that is necessary. To clean the skin around the PEG tube, lift up the flap, inspect the area; wash the skin with soap and water and dry the skin completely. Most PEG tubes do not need a dressing. A small amount of drainage is normal. Turn the tube with each feeding to prevent skin irritation.

If the tube becomes too loose, spacers may be placed between the PEG and the skin to provide a better fit. If the tube gets too tight and there are spacers in place, these can be removed anytime, by your GI nurse or doctor.

After three months you may choose to replace the PEG with the same type of tube or you may change to a balloon type gastrostomy tube. Talk with your nurse or doctor about the best tube for your child. If the tube is working well and does not need to be changed at 3 months, it may stay in for up to one year.

PEG Tube Extension Sets

You will receive three types of extension sets. An extension set is a special tube that connects to the gastrostomy tube and allows formula, liquids and medicines to be given into the stomach. There is 1) a bolus set, 2) a right angle set and 3) a decompression tube. The bolus set is used for feedings given by gravity through a syringe. The right-angle set is used for slow or continuous feedings given by a pump. The decompression tube (which has a long tip which opens a valve at the base of the tube) allows air and formula to be drained from the stomach if needed. The decompression tube is used if a child has too much gas (which can’t be burped up) or if the child is very uncomfortable and appears to have a bloated or full abdomen. The nurses taking care of your child will show you how to attach and remove each extension tube.

PEG extension tubes must be the same size as the gastrostomy tube in order to fit. PEG tubes have two measurements, the diameter (width) measured in French (FR) size and the length measured in centimetres (CM). These numbers are printed on the inside flap of the PEG. The bolus set and the right angle set must be the same diameter (for example 14 Fr) as the PEG tube. The decompression tube must be the same diameter and the same length (for example 14 Fr and 1.7 cm) in order to fit. We recommend that you write down the size of your child’s tube on this document or some place where you can find it when needed. This will help you when reordering supplies and talking with your child’s doctors and nurses. The office will also have a record of your child’s tube size.–procedures/gastrostomy-tubes.aspx

I found this thought it could show new Parents the view from a New Mum with a New Born Baby with a feeding tube.

I Personally have been tube feeding my own daughter last 14 years (2018) from the age of 3 years old, it is mind-blowing at first, but trust me, it does become easy once you are over the shock.


Nasogastric tube (NG tube)

A nasogastric tube (NG tube) is a special tube that carries food and medicine to the stomach through the nose. It can be used for all feeding’s or for giving a person extra calories. It is important to take good care of the feeding bag and tubing so that they work properly.

Don’t Panic your Hospital will teach you how to clear if it gets blocked, and always remember, your not the first to go through this, once you get the hang of it your feel right at home doing it in front of other’s, after all, said and done, your child needs feeding.

NG 7Word of warning, If you get the chance carry a spare, it case Baby pulls one out, and Hospital doesn’t carry the size you need.

NG 6

This tube is taped to the child’s Face


NG 3 Allow time for feed to go down this small tube. NG 4Three ways of feeding this way, 3rd being via a Pump.

This Site from a USA Hospital is a good thing to look though if your New to this.


A Facebook Group you might like to join



Panic sets in when your child pulls the tube out, but we might have found something to help you, with a 15% discount on your FIRST ORDER


Go look on the page above.


What is a Jejunostomy Tube (J-Tube)

Jejunostomy is a surgical procedure in which a hole is made in the small intestine in order to insert a feeding tube.  A patient may be given this operation if he has difficulty maintaining a healthy body weight by consuming food through the mouth. A jejunostomy tube (J-tube) may be used to introduce nutritious liquids and medicines to the body when the stomach is not fit for a feeding tube or in order to drain unwanted gases and liquids from the stomach.

NOTE,  Children who suffer from BAD Reflux or poor gastric movement or who have had the op to lift the stomach up around the base of the oesophagus, or can not have a gastrostomy tube inserted, then this might be the way forward


This procedure is typically recommended for patients who have a pancreatic disease, have difficulty emptying the stomach, or have a problem with the pulmonary aspiration of gastric contents, which occurs when the stomach contents are inhaled into the lungs. As an alternative to a gastronomy, in which the feeding tube is inserted into the stomach, a jejunostomy may also be used when the stomach needs to be kept strong for further surgeries. 

The procedure is so named because the hole, or stoma, is made in the middle portion of the small intestine, or jejunum. The small intestine is a long tube that makes up part of the lower gastrointestinal tract, through which food moves to be digested. Sitting between the stomach and the large intestine, the small intestine is responsible for continuing to break down food that has already been partially digested in the stomach as well as absorbing the food’s nutrients. The remaining matter is then passed on to the large intestine, where the waste is prepared to be excreted. The jejunum segment of the small intestine is situated between the duodenum, which attaches to the stomach, and the ileum, which connects to the large intestine.



A jejunostomy can either be performed as an open surgery, in which the patient is cut open to fully reveal the targeted tissue or as a laparoscopic procedure. In a laparoscopic operation, the patient will be anaesthetized, and the surgeon will make tiny incisions in the belly through which a laparoscope and tools can be inserted. The laparoscope is an imaging device that allows medical professionals to see a real-time movie of the inside of the body without open surgery.

J Tube 3

Once the incisions have been made, the J-tube is pushed through the abdominal wall. If the belly were divided into four boxes or quadrants, the tube entrance would typically be made in the upper left quadrant. A small incision, usually of about 0.12 inches (3 mm), is then made in the jejunum and the tube is inserted so that its opening is in the lumen of the intestine. The lumen is the open space or canal in the centre of the intestine. After removing the instruments and cleaning the incision sites, the patient should be ready to attach a feeding set and begin using the J-tube.

Depending on the reason that the surgery is being performed, the patient may be able to return home and administer food and medicine independently. Nurses or doctors will brief the patient or Parents on how to use and maintain the feeding tube based on the particular case at hand. Generally, the tube and the skin around the tube should be cleaned daily with cotton pads or a washcloth and soapy water. The patient should be careful, however, not to get the area too wet when showering or taking a bath for the first four to six weeks. The tube should be flushed out with tepid water every six hours or after every feeding, as well as every time feeding is interrupted.

If the J-tube site requires a dressing, this should also be changed on a daily basis. Patients should tell a healthcare professional if they experience redness, pain, swelling, or cracking of the skin surrounding the tube. The tube should also be secured to the body so as to prevent any pulling on the intestine. If the tube falls out, the opening should be covered with a fresh gauze pad and a medical professional should be notified.

J Pads You can buy these or make them yourself….


A New Treatment for Medication-Refractory Gastroesophageal Reflux Disease

David Adams, M.D., Head of the Division of Gastrointestinal and Laparoscopic Surgery at the Medical University of South Carolina, discusses the new LINX® reflux management system (Torax Medical, Minneapolis-St. Paul, MN), a device consisting of a “necklace” of magnetized titanium beads that can be placed around the lower esophageal sphincter to provide better closure and prevent reflux in patients with medication-refractory gastroesophageal reflux.



Tube Removal



How Is a Feeding Tube Removed?

How Is a Feeding Tube Removed?

 Feeding tube removal is usually performed by a licensed health care professional, either a nurse or physician. Nasogastric feeding tubes are rigid plastic tubes that are inserted through the nose and passed down through the oesophagus to rest in the stomach. Duodenal feeding tubes are soft rubber tubes passed with the aid of a guide wire (which is later removed) into the stomach and then beyond it to the duodenum (the part of the small intestine just inches beyond the stomach). Percutaneous endoscopic gastrostomy, or “PEG” tubes, are inserted through the abdominal wall with the aid of an endoscope that has been passed from the mouth into the stomach. Nasogastric and duodenal feeding tubes are semi permanent solutions that are left in place for days or weeks, whereas PEG tubes can be left in for years. The process of removal depends on the type of tube.

Nasogastric or Duodenal Tube

Nasogastric and duodenal feeding tubes are generally secured to the nose using tape or some other method. The tape is removed; and with the patient sitting as upright as possible, gentle traction is placed on the tube to begin the withdrawal process from the stomach or the duodenum. Duodenal feeding tubes are typically smaller than hard plastic nasogastric tubes, and extra care is taken during removal as they can stretch and break. As the end of the tube gets near the top of the oesophagus, the nurse will likely pause and give the patient a moment to rest. When the patient is ready, the tube is pulled quickly through the oropharynx and out through the nose. This may stimulate the gag reflex, but only very temporarily until the tube is out.

PEG Tube

Percutaneous feeding tubes are generally removed by a gastroenterologist or general surgeon. Removal typically involves deflating a balloon on the far end of the tube and withdrawing the tube through the abdominal wall to the outside. Some PEG tubes have a “bumper” that prevents pulling the tube through to the outside, in which case the tube is cut from the inside during an endoscopic procedure and removed through the mouth. In most cases, the external PEG openings are small and heal without formal intervention, but larger openings may need to be closed with sutures.

Removing the Tube

If and when the doctor decides that your child is able to take in enough nutrition by mouth, the G-tube or button will be removed. Removal takes only minutes and is usually done in the office by the doctor or nurse.

Once the button or G-tube is out, a small hole will remain. It will need to be kept clean and covered with gauze until it closes on its own. In some cases, surgery is necessary to close the hole. Either way, the scar that remains will be small.


you-tube video of a Child having G-Tube Removed


Tube Removal: Cautions and Complications

From the Parent

I had to write this. My goal isn’t to scare parents who have kids getting their tubes removed. It’s just a warning to be cautious.

Getting a feeding tube removed is supposed to be a time for celebration. We waited four long years for my son Spencer to be tube free. We had his feeding tube removed on March 6th, 2014, in the clinic with his GI doctor. In theory, the stoma was supposed to close on its own, or leak a tiny bit and need surgical closure a couple weeks later. However, with Spencer, nothing ever goes as planned.



Has your child become dependent on the feeding tube?

We are focused on teaching children to learn how to eat whether they are suffering from tube dependency or other early eating behaviour disorders. Our highly-specialized team is comprised of the most senior experts in tube weaning and early eating disorders with more than 30 years of clinical experience. Members of our team are based around the world enabling us to wean children off the feeding tube beyond language barriers.

Tube dependency is a rare and severe condition where a child becomes dependent on a feeding tube for nutrition even when he or she is capable of learning how to eat. 

The negative side effects of tube dependency can become overwhelming and have a dramatic effect on both the child and the family. 

Tube dependency can negatively impact a child’s growth, health, and further development. 

Studies estimate that one of every 20 children who receive temporary feeding tubes become tube dependent.


Useful Links...