Bio

Clinical Focus


  • Gastroenterology/Nutrition/Hepatology, Pediatric
  • Pediatric Gastroenterology

Academic Appointments


Administrative Appointments


  • Division Chief Pediatric Gastroenterology, Santa Clara Valley Medical Center (1998 - Present)

Professional Education


  • Residency:University Of Puerto Rico (1988) PR
  • Fellowship:Stanford University School of Medicine (1991) CA
  • Board Certification: Pediatric Gastroenterology, American Board of Pediatrics (2001)
  • Internship:University Of Puerto Rico (1984) PR
  • Medical Education:University of Puerto Rico (1983) Puerto Rico
  • Gastorenterology Fellowship, Stanford University, Gastroenterology (1991)
  • Pediatrics, University of Puerto Rico, Pediatrics (1986)
  • Medical Doctorate, University of Puerto Rico, Medicine (1983)

Research & Scholarship

Current Research and Scholarly Interests


Gastroenterology, liver disease in cystic fibrosis patients, percutaneous gastrostomy tube in pediatric population, inflamatory bowel disease, failure to thrive

Teaching

2013-14 Courses


Publications

Journal Articles


  • Treatment of catheter occlusion in pediatric patients JOURNAL OF PARENTERAL AND ENTERAL NUTRITION Kerner, J. A., Garcia-Careaga, M. G., Fisher, A. A., Poole, R. L. 2006; 30 (1): S73-S81

    Abstract

    A proper initial assessment of catheter occlusion is the key to successful management. The assessment screens are for both thrombotic and nonthrombotic causes (including mechanical occlusion). If mechanical occlusion is excluded, thrombotic occlusion is treated with alteplase. Nonthrombotic occlusions are treated according to their primary etiologies: lipid occlusion is treated with 70% ethanol, mineral precipitates are treated with 0.1-N hydrochloric acid (HCl), drug precipitates are treated according to their pH-acidic drugs can be cleared with 0.1-N HCl, basic medications can be cleared with sodium bicarbonate or 0.1-N sodium hydroxide (NaOH). Prevention of occlusion of central venous access devices is also critical. To date, no data conclusively show heparin flushes to be superior to saline flushes. No prophylactic regimen, including low-dose warfarin, low-molecular-weight heparin, or 1 unit heparin/mL of parenteral nutrition has been endorsed by any major medical, nursing, or pharmacy group due to lack of scientific evidence. The most encouraging information on decreasing occlusion rate comes from experience with positive-pressure devices that attach to the hub of most catheter lumens and prevent retrograde blood flow and, consequently, decrease the risk of thrombus formation in the catheter lumen.

    View details for Web of Science ID 000248557900013

    View details for PubMedID 16387916

  • Gastrointestinal manifestations of food allergies in pediatric patients. Nutrition in clinical practice Garcia-Careaga, M., Kerner, J. A. 2005; 20 (5): 526-535

    Abstract

    Foods that account for 90% of allergic reactions in children are cow's milk protein, eggs, peanut, soy, tree nuts, fish, and wheat. Food allergy can manifest as urticaria/angioedema, anaphylaxis, atopic dermatitis, respiratory symptoms, or a gastrointestinal (GI) disorder. GI allergic manifestations can be classified as immunoglobulin E (IgE) mediated (immediate GI hypersensitivity and oral allergy syndrome); "mixed" GI allergy syndromes (involving some IgE components and some non-IgE or T-cell-mediated components) include eosinophilic esophagitis and eosinophilic gastroenteritis. Non-IgE-mediated or T-cell-mediated allergic GI disorders include dietary protein enteropathy, protein-induced enterocolitis, and proctitis. All these conditions share a common denominator: the response of the immune system to a specific protein leading to pathologic inflammatory changes in the GI tract. This immunological response can elicit symptoms such as diarrhea, vomiting, dysphagia, constipation, or GI blood loss, symptoms consistent with a GI disorder. The detection of food allergies can be accomplished by the use of radioallergosorbent (RAST) testing and skin prick tests in helping to assess the IgE-mediated disorders. Patch tests may help evaluate delayed hypersensitivity reactions. Treatment of GI allergic disorders ranges from strict dietary elimination of offending food(s), use of protein hydrolysates, and use of L-amino acid-based formula when protein hydrolysates fail. Treatment with topical (for eosinophilic esophagitis) or systemic steroids is used if all dietary measures are unsuccessful. Maternal breast feeding or the use from birth of hydrolysate formulas (extensive or partial hydrolysates) may be efficacious in the prevention of atopic disease in "high-risk" families (with at least 1 parent or sibling with a history of atopic disease).

    View details for PubMedID 16207693

  • Gastrointestinal bleeding CLINICAL PEDIATRICS Nguyen, P. C., Garcia-Careaga, M., Bass, D. 2005; 44 (7): 641-643

    View details for Web of Science ID 000231687200015

    View details for PubMedID 16151574

  • A practical guideline for calculating parenteral nutrition cycles. Nutrition in clinical practice Longhurst, C., Naumovski, L., Garcia-Careaga, M., Kerner, J. 2003; 18 (6): 517-520

    Abstract

    Both physiologic and psychological reasons for cycling total parenteral nutrition (TPN) have been well established. Despite widespread acceptance of this practice, the only previously published method for calculating TPN cycle rates is inherently flawed.A mathematical formula was derived to facilitate reliable calculation of cyclic TPN flow rates as a function of total volume and cycle time. A publicly accessible website was subsequently developed to expedite rapid determination of TPN cycles.A fail-safe method of calculating TPN cycle flow rates can be expressed as F = V/(4T-10), where F is equal to the basal flow rate (mL/h), T is equal to the desired cycle time (hours), and V is equal to the total volume of TPN (mL) to be delivered in 24 hours. The basal flow rate and twice the basal flow rate are used for the first and last 2 hours of the TPN cycle, and the remainder of the cycle runs at 4 times the basal flow rate. TPN cycles may be easily calculated online using this formula at http://peds.stanford.edu/tpn.html.We have developed a fail-safe method of calculating TPN cycle flow rates that will consistently deliver the desired volume and have made an online implementation of this formula publicly available.

    View details for PubMedID 16215087

  • Gastrointestinal dysfunction associated with syringomyelia and hydromyelia JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION Garcia-Careaga, M., Cox, K. M., Blankenberg, F., Cox, K. L. 2000; 31 (1): 71-75

    View details for Web of Science ID 000087924200016

    View details for PubMedID 10896075

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