As a Pediatric Gastroenterologist, my clinical focus is to deliver advanced clinical care to children and adolescents with gastrointestinal and liver diseases, with an emphasis on the important role of nutrition.

Clinical Focus

  • Pediatric Gastroenterology
  • Pediatric Obesity
  • Nutrition Disorders
  • Intestinal Failure
  • Short Bowel Syndrome

Academic Appointments

Administrative Appointments

  • Pediatric GI Advocacy Co-Chair, Stanford University, Department of Pediatrics, Division of Pediatric Gastroenterology (2023 - Present)

Honors & Awards

  • High Value Innovation Award: Improving Care for Intestinal Failure Patients with IR Rounds, Stanford Health Care System (2019)

Boards, Advisory Committees, Professional Organizations

  • Member, Nutrition Committee, North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (2021 - Present)
  • Member, Intestinal Rehabilitation Special Interest Group, North American Society for Pediatric Gastroenterology, Hepatology, & Nutrition (2020 - Present)
  • Member, Fellow's Committee, North American Society for Pediatric Gastroenterology, Hepatology, & Nutrition (2020 - 2022)
  • Member, American Academy of Pediatrics (2015 - Present)

Professional Education

  • Board Certification: American Board of Pediatrics, Pediatric Gastroenterology (2023)
  • Board Certification: American Osteopathic Board of Pediatrics, Obesity Medicine (2022)
  • Graduate Education (MA), Boston University, Medical Sciences (2010)
  • Medical Education (DO), Kansas City University of Medicine and Biosciences, Medicine (2015)
  • Residency, Louisiana State University, New Orleans, Pediatrics (2018)
  • Chief Residency, Louisiana State University, New Orleans, Pediatrics (2019)
  • Fellowship, Stanford University, Pediatric Gastroenterology (2022)
  • Advanced Fellowship, Children's Hospital of Philadelphia, Nutrition (2023)
  • Board Certification, American Board of Pediatrics, Pediatrics (2018)
  • Board Certification, American Board of Obesity Medicine, Obesity (2021)
  • Board Certification, National Board of Physician Nutrition Specialists, Nutrition (2023)
  • Board Certification, American Board of Pediatrics, Pediatric Gastroenterology (2023)

Current Research and Scholarly Interests

As a pediatric physician-investigator, I strive to understand the role of nutrition and diet therapy in pediatric health. I am particularly interested in understanding and developing novel treatment plans for adolescent patients with obesity and in establishing guidelines to improve health outcomes for pediatric intestinal failure patients.

Current research studies include novel treatment options for pediatric metabolic dysfunction-associated steatotic liver disease (MASLD), health equity in pediatric patients with intestinal failure, and medication management after metabolic and bariatric surgery in pediatric patients with severe obesity.

All Publications

  • Sleeve gastrectomy for the treatment of adolescent obesity in children aged 13 and under: a retrospective study. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery Liang, N. E., Herdes, R. E., Balili, R., Pratt, J. S., Bruzoni, M. 2023


    Sleeve gastrectomy (SG) induces weight reduction and improves metabolic co-morbidities in children with severe obesity but remains underutilized, especially for young adolescents and preadolescents.We hypothesized there would be no differences in weight loss or co-morbidity resolution at 1 year post-SG in children who underwent SG at 13 years or younger compared to children who underwent SG at 17-18 years old.Academic medical center, United States.Medical records of children who underwent laparoscopic SG at a quaternary academic center from September 2014 to October 2022 were reviewed. A cohort of 15 patients, ≤13 years of age, was compared to a matched cohort of 15 older adolescent patients. Preoperative characteristics and postoperative outcomes were collected.Both cohorts had similar baseline characteristics. Median preoperative body mass index (BMI) was 51.8 kg/m2 for the ≤13 cohort compared to 50.9 kg/m2 in the older cohort (P = .87). Time to postoperative enteral feeds and length of stay were similar between both groups, and there were no 30-day readmissions or immediate postoperative complications. Median percentage excess BMI loss at 1 year postoperation was 54% (IQR, 25.5%-94.5%) for the ≤13 cohort compared with 44% (IQR, 34.0%-51.0%) for the older cohort (P = .34). Two of 11 patients were lost to follow-up in the younger group compared to 4 of 15 in the older group (P = .61). Both groups demonstrated significant improvement in metabolic syndrome co-morbidities after SG.SG in younger children is associated with successful postsurgical outcomes compared with adolescents, with effective weight loss and improvement of obesity-related metabolic co-morbidities.

    View details for DOI 10.1016/j.soard.2023.12.005

    View details for PubMedID 38195315

  • Pancreatic Fluid Leak Causing Mediastinal Shift. Journal of pediatric gastroenterology and nutrition Herdes, R. E., Syed, A. B., Gugig, R. 2022

    View details for DOI 10.1097/MPG.0000000000003640

    View details for PubMedID 36245077

  • Pitfalls of Iron Supplementation in Parenteral Nutrition Admixtures for Children with Intestinal Failure. JPEN. Journal of parenteral and enteral nutrition Herdes, R. E., Oliveira, S. B., Kocoshis, S. A., Bernieh, A., Namjoshi, S. S. 2022


    BACKGROUND: Pediatric patients with intestinal failure are at increased risk for iron deficiency. Supplementation is not routinely included in parenteral nutrition solutions. There is currently limited research related to the safety of iron supplementation in parenteral nutrition and for intravenous forms used in patients with intestinal failure. Current ASPEN and ESPGHAN guidelines promote the use of enteral iron, acknowledging the risks of using iron supplementation within parenteral nutrition admixtures.METHODS: We review a patient case and the current available literature related to iron in parenteral nutrition.RESULTS: Five major concerns are identified: peroxidation reactions, incompatibility, hypersensitivity, infection risk, and iron overload.CONCLUSION: We propose an argument against the preferential use of iron supplementation within parenteral nutrition in children with intestinal failure when enteral supplementation or intermittent parenteral infusion may be sufficient.CLINICAL RELEVANCY STATEMENT: Pediatric patients with intestinal failure are at risk for iron deficiency anemia, anemia due to folate or B12 deficiency, vitamin B6 deficiency, copper deficiency, non-anemic iron deficiency, and anemia of inflammation. Iron status assessment and supplementation for these patients is variable over time. There are several biochemical and physiologic concerns about the safety of adding iron supplementation to parenteral nutrition admixtures. This paper briefly reviews the current available literature. Further research is needed to evaluate best practices for iron supplementation for pediatric patients with intestinal failure. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1002/jpen.2428

    View details for PubMedID 35730416

  • Effect of telehealth implementation on an adolescent metabolic and bariatric surgery program. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery Herdes, R. E., Matheson, B. E., Tsao, D. D., Bruzoni, M., Pratt, J. S. 2022


    Pediatric severe obesity is a worldwide health concern. Treatment with metabolic and bariatric surgery can reduce morbidity and mortality. The COVID-19 pandemic not only has had a significant effect on rates of pediatric obesity but also has necessitated a rapid transition to virtual medicine.We aimed to identify and examine adolescent metabolic and bariatric surgery patient participation rates through our program's virtual telehealth programming as compared with prepandemic traditional in-person clinic appointments.This study took place at an academic pediatric quaternary care center.We evaluated 92 adolescent patients with a total of 2442 unique encounters between January 2018 and July 2021.The rate of attendance was found to be greater for telehealth visits (83.1%) than for in-person appointments (70.5%) for all clinics regardless of appointment type (preoperative versus postoperative). Cancellation rates were lower for telehealth visits (9.9%) than for in-person appointments (22.5%).This study provides evidence that telehealth can be implemented successfully in an adolescent metabolic and bariatric surgery program and can improve attendance rates for all provider and appointment subtypes.

    View details for DOI 10.1016/j.soard.2022.05.014

    View details for PubMedID 35753896

  • Bacterial overgrowth assessment and treatment among pediatric intestinal rehabilitation & nutrition support providers: an international survey of clinical practice patterns. JPEN. Journal of parenteral and enteral nutrition Namjoshi, S. S., Galloway, D., Herdes, R. E., Talathi, S., Ding, V. Y., Mezoff, E. A. 2022


    BACKGROUND: Small bowel bacterial overgrowth (SBBO) is a common, but difficult to diagnose and treat problem in pediatric short bowel syndrome (SBS). Lack of clinical consensus criteria and unknown sensitivity and specificity of bedside diagnosis makes research on this potential SBS disease modifier challenging. The objective of this research was to describe clinical care of SBBO among international intestinal rehabilitation and nutrition support (IR&NS) providers treating patients with SBS.METHODS & MATERIALS: A secure, confidential, international, electronic survey of IR&NS practitioners was conducted between March 2021 and May 2021. All analyses were conducted in the R statistical computing framework , version 4.0 RESULTS: 60% of respondents agreed and 0% strongly disagreed that abdominal pain, distension, emesis, diarrhea, and malodorous stool, were attributable to SBBO. No more than 20% of respondents strongly agreed and no more than 40% agreed that any sign or symptom was specific for SBBO. For a first-time diagnosis, 31 practitioners agreed with use of a 7-day course of a single antibiotic, with a majority citing Grade 5 evidence to inform their decisions (case series, uncontrolled studies, or expert opinion). The most common first antibiotic used to treat a new onset SBBO was metronidazole, and rifaximin was the 2nd most commonly used. 100% of respondents reported they would consider a consensus algorithm for SBBO, even if the algorithm may be divergent from their current practice.CONCLUSION: SBBO practice varies widely among experienced IR&NS providers. Development of a clinical consensus algorithm may help standardize care to improve research and care of this complex problem and to identify risks and benefits of chronic antibiotic use in SBS. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1002/jpen.2369

    View details for PubMedID 35274342

  • Why earlier may be better: a look at the use of metabolic and bariatric surgery in the treatment of severe childhood obesity. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery Herdes, R. E., Tsao, D. D., Pratt, J. S. 2021

    View details for DOI 10.1016/j.soard.2021.09.003

    View details for PubMedID 34565685

  • 50 Years Ago in TheJournalofPediatrics: Our Evolving Understanding of Pediatric Malnutrition. The Journal of pediatrics Herdes, R. E., Oliveira, S. B. 2021; 235: 137

    View details for DOI 10.1016/j.jpeds.2021.04.065

    View details for PubMedID 34304760

  • An Unusual Case of Thiamine Deficiency in a Total Parenteral Nutrition-Dependent Child Secondary to Munchausen by Proxy. JPGN reports Huang, A. C., Herdes, R. E., Yamin, G., Kerner, J. 2021; 2 (1): e044

    View details for DOI 10.1097/PG9.0000000000000044

    View details for PubMedID 37206950

    View details for PubMedCentralID PMC10191465

  • Experience With Vertical Sleeve Gastrectomy in Adolescent and Young Adult Ehlers-Danlos Syndrome Patients: a Case Series and Review of the Literature Obesity Surgery Herdes, R. E., Abu El Haija, M., Johnson, K., Shepard, W., Zak, Y., Bruzoni, M., Pratt, J. S. 2021
  • Considerations on the role of esophagogastroduodenoscopy in the pediatric metabolic and bariatric surgery patient Surgery for Obesity and Related Diseases Abu EL Haija, M., Browne, N. T., Griggs, C. L., Herdes, R. E., Michalsky, M. P., Ogle, S. B., Zitsman, J. L., Pratt, J. S. 2021
  • Initial Presentation of a Pediatric Intestinal Pseudo-Obstruction Episode After SARS-CoV-2 Virus (COVID-19) Infection JPGN Reports Herdes, R., Cagil, Y., Namjoshi, S. S., Hassan, M. 2021
  • Self-Efficacy in Children with Functional Constipation Is Associated with Treatment Success. The Journal of pediatrics Santucci, N. R., Rein, L. E., van Tilburg, M. A., Karpinski, A., Rosenberg, A., Amado-Feeley, A., Stoops, E., Herdes, R. E., Hyman, P. E. 2020; 216: 19-24


    To assess the relationship between self-efficacy, the belief that an individual can succeed at a goal, and short-term treatment outcome in children with functional constipation.Patients with functional constipation age 8-16 years completed the Self-Efficacy for Functional Constipation Questionnaire (SEFCQ), consisting of 14 statements about performing tasks needed for defecation. Patients completed SEFCQ before, immediately after, and 3 weeks after their clinic visit. Treatment success was defined as ≥3 bowel movements into the toilet and no fecal incontinence in the third week.75% of patients had a successful outcome. Scores were higher in the group that was successful than in those that failed before, immediately after the visit, and 3 weeks later (P < .001). Self-efficacy improved at all time points in the group that was successful (P < .001). In the group that failed, scores improved immediately after clinic visit (P < .01) but were unchanged at follow-up (P > .05).Improved self-efficacy is associated with successful outcomes in children with functional constipation, thus, it may be beneficial to enhance self-efficacy for defecation during treatment.

    View details for DOI 10.1016/j.jpeds.2019.08.062

    View details for PubMedID 31679634