Propofol is safe and effective for facilitating EGD in children.

Thickening of formula with rice cereal in a nutritionally balanced form and smaller volume may be an appropriate strategy for reducing frequency of emesis and gastroesophageal reflux in thriving infants.

Infants with respiratory syncytial virus (RSV) bronchiolitis have an increased risk of aspiration. The optimal feeding strategy for these patients has not been described. Fifteen previously healthy and clinically stable infants with RSV bronchiolitis underwent video-fluoroscopy studies to assess swallowing using thin barium. Those with abnormal studies underwent a repeat study, using barium that was thickened with rice cereal. Nine of 15 infants had abnormal studies with thin barium. Laryngeal or tracheal penetration with thin barium was seen in 3 and 2 infants, respectively, but not with thickened barium. Aspiration of thin barium was seen in 4 infants, but it corrected in 3 of these 4 infants with thickened barium. Thickened feeds provide a simple, safe, and cost-effective intervention to improve swallowing dysfunction and prevent aspiration in infants with RSV bronchiolitis.

Objective: Whey-based formulas have faster gastric emptying than casein-based formulas. Isoenergetic, isovolumic, whey-based formulas of different osmolarity and fat content empty in a similar manner. Will the gastric emptying of high and low energy density whey-based formulas be similar? Design: We studied the gastric emptying rate of equal volumes of two whey-based formulas of different energy density (4.18 kJ=ml and 6.27 kJ=ml) and osmolality (270 and 450 mOsm=kg, respectively) in 10 children (4.5 -12 y) with volume intolerance and resultant inability to gain weight. Results: The two formulas had comparable gastric emptying rates at 30, 60, 90 and 120 min. Over a one month clinical trial, substitution of the lower energy density whey-based formula (no weight gain over 2 months) with an equal volume of the high energy density formula produced a mean weight gain of 1.17 AE 0.5 kg per patient without change in tolerance. Conclusion: The higher density whey-based formula can safely substitute an equal volume of a lower energy density formula to produce weight gain without affecting tolerance. Implication: This provides an important intervention for increasing energy intake in children with volume intolerance or fluid restriction.

Achalasia is the best described motor disorder of the esophagus. Associations with familial glucocorticoid deficiency and alacrima (triple A syndrome) have been described in the pediatric population, but no attention has been paid to the possibility of this association in adults. Tear production was assessed in 20 patients with achalasia and 20 age- and sex-matched controls. Deficient tears were found in four achalasics compared with none among the controls (P < 0.05). This suggests that some variant of the triple A Syndrome (achalasia, alacrima, and adrenocortical insufficiency) may exist in adult patients with achalasia as well.