The Use of High Bile-binding Foods to Reduce Upper Gastrointestinal Bile Acid Concentrations (Aim 2)

Pediatric patients ages 5 to 21 in the randomized arm Inclusion criteria * receive at least 80% of their nutritional needs via gastrostomy * receive blenderized feeds or will start receiving blenderized feeds * have no known allergies to ingredients in blenderized feeds; * receive their bolus feeds within 30 minutes or less * can receive their feeds by syringe push Exclusion criteria * have undergone anti-reflux surgery * receive post-pyloric feeds * are allergic to any component of the administered diets * cannot receive their gastrostomy feeds over 30 minutes * require a feeding pump for feed administration (as the H-BBB is too thick for pump administration). Pediatric patients ages 5 to 21 in the observational arm Inclusion * receive at least 80% of their nutritional needs via gastrostomy * are taking an amino acid formula * have not undergone antireflux surgery Exclusion * have undergone anti-reflux surgery * receive post-pyloric feeds * are not receiving an amino acid-based formula.