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Suggest Treatment For Blood Presence In Diarrhea
Question: Hi! My 3 year old had a bout of bloody diarrhea, although she felt fine, back in Dec. She had a high fever so it was assumed she had a bacterial infection and eventually went away. The blood only lasted 2 days. The diarrhea, a few weeks. She finally got better. She has never had formed stools in her life, but was breastfed for 3 years, so we assumed that was why. Several weeks after recovering, she got bloody diarrhea again. This time, it wasnt bad, only lasting a day or two with high fever. The pediatric gastroenterologist performed a colonoscopy and EGD. Upon visual inspection of her colon, he diagnosed her with Ulcerative Colitis (pan colitis). Her CT scan showed thickening in the sigmoid colon. She was put on Pentasa and a probiotic VSL3. She has had formed stool since. The pathology report came back as indeterminate colitis. We got her labs back this week and found that her IBD panel was negative for Crohns or Ulcerative Colitis. I realize there is no research on the IBD panel in children, but what would the possible causes for this negative result? We are continuing the Pentasa (5-ASA) and probiotic for a few years and her doctor will do another scope to see how she is healing. Is there anything that could mimic ulcerative colitis? Is it possible that she was misdiagnosed?
Brief Answer:
May or may not IBD
Detailed Answer:
Hi....I remember answering your question previously about the same issue.
At that time I remember telling about IBD.... I told you that we can wait as the symptoms were not perfectly fitting into IBD. My exact statement is here under -
1. This is not inflammatory bowel disease for the reasons, the kid is not running temperature consistently/ no rash on skin or high shins/ joint pains and most importantly she's gaining weight.
2. It can take even 2 weeks for the colitis or bacillary dysentery to settle.
3. It is common for occasional blood streaks for about 2 weeks.
If all this symptoms persist for more than this consistently, with associated weights loss, then we will consider inflammatory bowel disease. Do not worry.
But I am glad that you have gone ahead with the scopy as she had a repetition of the symptoms and the gastroenterologist felt that it could be ulcerative colitis.
Coming to your queries -
1. IBD needs high index of suspicion for diagnosis and even after we clinically suspect the disease, it is very difficult to perform a gold standard confirmatory diagnostic test as non is available. There are no possible causes for the negative results as no test has been standardized in kids.
2. Even if the tests are negative it could still be IBD as the kid has improved symptomatically.
3. The chances of misdiagnosis are less as the kid had bloody stools recurrently which took longer than usual time to recover from.
4. The plan of using medicines as of now (for which she is responding) and going ahead with another scopy at a later point of time seems perfectly logical to me and I to suggest you the same.
Regards - Dr. Sumanth
May or may not IBD
Detailed Answer:
Hi....I remember answering your question previously about the same issue.
At that time I remember telling about IBD.... I told you that we can wait as the symptoms were not perfectly fitting into IBD. My exact statement is here under -
1. This is not inflammatory bowel disease for the reasons, the kid is not running temperature consistently/ no rash on skin or high shins/ joint pains and most importantly she's gaining weight.
2. It can take even 2 weeks for the colitis or bacillary dysentery to settle.
3. It is common for occasional blood streaks for about 2 weeks.
If all this symptoms persist for more than this consistently, with associated weights loss, then we will consider inflammatory bowel disease. Do not worry.
But I am glad that you have gone ahead with the scopy as she had a repetition of the symptoms and the gastroenterologist felt that it could be ulcerative colitis.
Coming to your queries -
1. IBD needs high index of suspicion for diagnosis and even after we clinically suspect the disease, it is very difficult to perform a gold standard confirmatory diagnostic test as non is available. There are no possible causes for the negative results as no test has been standardized in kids.
2. Even if the tests are negative it could still be IBD as the kid has improved symptomatically.
3. The chances of misdiagnosis are less as the kid had bloody stools recurrently which took longer than usual time to recover from.
4. The plan of using medicines as of now (for which she is responding) and going ahead with another scopy at a later point of time seems perfectly logical to me and I to suggest you the same.
Regards - Dr. Sumanth
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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