Which gastroenterologist?

[Anonymous]

Hi, all! I hope you can help me (as you have with other issues!), even though this one is more strictly medical.

My son has had reflux since infancy and is on Prevacid. He is now 6, and his pediatrician would like him to be evaluated by a pediatric gastroenterologist for his reflux and for possible eosinophilic esophagitis. The pediatrician gave us a list of many doctors from which to choose; whom would you choose, and why?

If it helps, DS is very bright, has some sensory issues, and prefers someone who speaks to him warmly and treats him gently. I prefer someone with strong academic credentials who can speak to me as if I'm not an idiot, and long enough to answer my questions. I also have a preference for a well-reputed teaching hospital, but have not lived here long enough to know which those are. We're in the Vienna/Oakton area of NoVA, and I would be very grateful for your advice. Thank you!

Here's the list:

Fairfax Inova Hospital:
Peter Lee, Catherine Chao, Lynn Duffy, Benjamin Enav, Otto Louis-Jacques

DC Children's:
Ali Bader, Benny Kerzner

Georgetown Hospital:
Agnieszka Pluta, Philip Rogers

[Anonymous]

My son saw Dr. Kerzner twice. I was very impressed with him. I don't know how he talks to kids, my son was just 13 months when we saw him so he was mainly talking to us. You can do a search on the General Parenting forum and specify "Kerzner" and see all the responses.

[Anonymous]

I would call Lynn Duffy's group and see the next doctor that has an available time slot in their Fairfax office. They all work very collaboratively there, so I don't think it matters which doctor you see. We see Dr. Benjamin Enav for my preschooler son and he has been great - very down to earth and seems to get along well with my son. He did a procedure on him at the hospital and it was a bit traumatizing for me to have him go under anesthesia but the doctor made sure that we knew everything was going well and that our baby was fine.

[Anonymous]

My DC has EE. We go to Hopkins... But, we have heard great things about the Fairfax Inova Hospital group. My DH also has EE and they were recommended as a second opinion for my DC.

We saw Dr. Pluta when DC was 4 months old for reflux issues. She was kind and knowledgable. Seemed to be plugged into reflux and food allergies. But, I can't speak to EE knowledge b/c we didn't know about that at the time.

I really hope it turns out to be "just" reflux. Not like that isn't bad enough, but EE really stinks.

[Anonymous]

Thanks, everyone! Fairfax Inova is most convenient for us, so I'm glad that so far they have a good reputation.

18:55: What made you decide to go to Hopkins for your DC? We're going there next month for my other child's food allergies, but pediatrician here didn't seem to think it was necessary for the reflux/possible EE. What do you think?

I'm tempted to ask you why EE stinks so bad, but I think I'll hold off for fear of scaring myself silly before having to wait weeks or months for an appointment.

[Anonymous]

We saw Benny Kerzner several times when my son was young, and were consistently impressed with his dedication, his knowledge and his bedside manner. I can't speak to any of the others, but I'm a huge fan of Dr. Kerzner, and I'm super picky about who sees my child.

[Anonymous]

18:55 PP back.

My DS sees Dr. Wood at Hopkins for Food Allergies. After trying a local GI we weren't thrilled with, we moved to Hopkins for GI also. One of the GIs there has a special interest in EE and EG.

My recommendation would be to go to a GI that understands both reflux and EE. Most GIs that understand EE will also have knowledge of reflux b/c they seem to go hand in hand in most cases. In EE, reflux can be secondary b/c of the inflammation. Or they can just co-exist. However the GI will likely be able to tell the difference based on the scope and biopsies.

The recommendation for Fairfax Inova should have Docs well versed in both conditions. But, I do believe that for food allergies, they work with Dr. Alpan instead of Hopkins for the allergy component.

What symptoms does your DS have? Is he on a PPI?

[Anonymous]

Thanks for the explanation, 18:55.

It sounds frustrating to deal with one person for the GI component and another for the allergy part, considering how inter-related they are in EE. How can I tell if a GI understands both? DS used to have a "regular," Ig-E, allergy to eggs, and still refuses to eat them plain, but does eat cooked things with them. DD has other "regular" allergies, so that's why she's going to Hopkins next month.

DS started in infancy with screaming and absolute misery after eating, after trying Zantac (useless) and dozens of other changes (sleeping in car seat, etc.) he finally started on Prevacid in applesauce, and stayed on it for a year or two. It helped, and eventually drs thought he could come off around age 2 or 3 (can't remember). But by age 4.5 - 5, he was complaining of tummy aches every day, so pediatrician put him back on Prevacid; he's been on it about a year this time (15 mg/day). He still complains of occasional tummyaches, but nothing like before. However, I still sometimes (especially at bedtime) see food coming up and his swallowing it back down. He says it doesn't hurt.

All advice continually welcome!

[Anonymous]

18:55 PP again.

It is frustrating to have 2 Doctors treating the same disease. They each have their speciality component to it....but it does get confusing. For the most part, I speak to the Allergist about the allergic condition causing the EE and EG and to the GI about the GI symptoms and results of the allergic condition.

Particularly b/c you have 2 children with allergy symptoms and 1 child with GI symptoms, it sounds reasonable to me to have DS checked to make sure eosiniphils aren't playing a role.
The symptoms you describe sound like either reflux, EE or both. The only way to know for sure is with the scope and biopsies.

FWIW (and all kids are different), my DS is 4.5 and only had/has a few foods he can tolerate (and that is still not certain) and primarily gets nutrition from formula. When he is having eos flares, he coughs when eating, gags and pockets food in his cheeks instead of swallowing it. He has horrible sleep patterns and consistently complains of being in pain. Occasionally he will throw up while eating (use to be much more when he was an infant). As I mentioned, kids can have varying degrees of EE, so don't think this is the way it has to be. Some kids have EE and only have to avoid a few trigger foods to be asymptomatic.

If you have any other questions, I'm happy to pass on what I know (or think I know :mrgreen

[Anonymous]

My infant son sees Dr. Pluta for GERD. I feel he's in great hands and she has effectively managed his condition (which at one point was so bad that he refused to eat due to pain). He's a happy and well-fed baby these days. I'm so grateful to her. She just opened a new office off of Montrose Road which is lovely with parking right in front. She also sees patients on Saturdays which is a huge help for us b/c I'm a working mom.

[Anonymous]

Thank you all for the info. Sounds like most of the docs have good feedback, so I think I'll go with whoever is closest (FFX) - unless someone wants to persuade me otherwise.