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Suffering from severe diarrhoea. What treatment should be done?

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Practicing since : 1962
Answered : 693 Questions
Dear Sir,
I am writing to your regarding my son XXXXXXX that this 6 years old. Me and me wife live together with our three sons in Sweden. XXXXXXX is besides this issue a health young man.

In may this year (approx. 5 months ago) XXXXXXX got a stomach flue that caused him diarrhea. The acute phase of the flu passed after a week, but the diarrhea did however not subside. Today, after 5 months of duration, XXXXXXX have 2 - 3 loose stools per day. The stools are most of the time watery, and sometimes loose/mushy. Maybe once each two weeks he have a normal stool, but that is on the rare side of things. Approximately three months ago we visited our family (GP) practitioner and a battery of tests were taken, (CRP, SR, glucose, as well as stool samples for Salmonella, Campyc, parasites etc.) Blood samples was also taken for celiac disease. The doctor also took a new test that is called F-calprotectin which aims to find elevation of calprotecin in feces which may indicate the presence of inflammation in the bowels. All tests returned negative, in terms of that there were no sign of infection neither inflammation nor any parasites. The loose stools XXXXXXX keep having were deemed as functional and no further work-up was planned for him.

Now, after a total of 5 months, and still no improvement of the loose stools we as parents would like an second opinion on the probability of a functional disorder. I should mention that we also keep in on a strict lactose free diet with no apparent improvement.

For you information XXXXXXX has since the outbreak not increased in weight, however he has increased in length by a few centimeters. He do not complain over stomach ache and besides the loose stools seems to be a health young man with as much energy as others at his age.

Our worries are if the loose stools can be fully attributed to a functional disorder stemming from the flue he had in May this year. However, it is my experience that functional disorders in the gut seldom only manifest as loose stools, they rather alter between constipation and loose stools. Your opinion on this would be highly appreciated.

XXXXXXX has no known hereditary for Inflammatory Bowel Disease, and he has not visited any countries outside Sweden that can indicate increased exposure for parasites.

Given this information, would you think that a further work-up is warranted? If so, what would be a good way to proceed?

Thank you!

Posted Mon, 12 Nov 2012 in Digestion and Bowels
Answered by Dr. Charles S Narasi 25 hours later
For nearly forty years I practiced gastroenterology mostly
dealing with adults. Although I have had occasional request
about a young boy or girl, I cannot say I am an expert
pediatric gastroenterologist which is a separate field altogether.
Having said that, I will try to provide you some general
guidelines regarding your six year old.
First of all , the symptoms seem to follow an infection of
some sort, like a gastroenteritis. I am glad the doctors have
ruled out parasitic or other infections by several stool studies.
Also Celiac disease by doing latest tests.
I am not sure if they have done a breath test for lactose
intolerance, although this may be a little difficult to do in a
I see he has had some tests for ruling out Crohn's disease
or ulcerative colitis.
All the newborns are tested for cystic fibrosis , so possibilty
of pancreatitis and diarrhea is unlikely.
There is also no family history of Inflammatory bowel disease.
You want to make sure that he is not taking any over the counter
medications including vitamins, which in some can cause diarrhea.
The frequency of 2-3 stools a day is not severe unless it is very
large and watery with loss of fluids and electrolytes.
One thing I suggest parents is to keep a detailed diary of all the food
and drinks that he consumes for a whole week and write down
how many times he goes to the bathroom and note the consistency
of the stool. Sometimes, just by looking at the list, you may be able
to come up with the culprit.
Make sure he is not chewing gum containing fructose or sorbitol.
That can also give diarrhea.
I would recommend that he get an x-ray studies of his stomach
and small bowel follow through to rule out "Malabsorption" due to
any intestinal abnormality.
If all of these are ruled out, possibility of "Functional XXXXXXX cause exists.
Irritable bowel in children is more common in middle school or high
school age but can occur in younger children.
Very rarely, endoscopy and biopsy studies may be needed.
Probiotics have been found to help build up good bacteria.
You can check with your pharmacist for these products. Plain,
cultured yogert is good.
Hope I have given some leads for you to work with.
Stress and emotional trauma due to some unexpected life event
can affect children too.
Wish him well.
Above answer was peer-reviewed by
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