Brief Answer: She will require Endoscopic examination Detailed Answer: Hi Mrs. XXXXX, Thanks for your query. Firstly, in order to PINPOINT the exact cause of your problems; give you a SOUND professional advice; and, TRUE VALUE FOR YOUR MONEY, I request you to kindly provide additional information as follows :- # Is your granddaughter passing through mental stress due to school/personal problems? # Does she have difficulty in swallowing both solids and liquids? # Does she complain of pain in upper part of stomach; acidity problem and/or frequent episodes of diarrhea? # At what time of the day does she start vomiting? does the vomit consist of undigested food material?? # Has she had weight-loss in the recent past, or complains of chest pain? However- pending receipt of additional information as requested- the possible causes of persistent vomiting (as deduced from the information provided by you) are :- * Factitious Vomiting, which is usually seen in children with psychological problems or mental stress. * Pyloric Stenosis, in which there is constriction of the valve at the other end of stomach. This condition can be congenital, but progressive and manifests in childhood when the narrowing is significant enough to prevent food from passing into the intestine. * H.pylori infection of the stomach, which causes increased acidity in the stomach, progressing into a condition called Gastro-esophageal-reflux-disease (GERD). In this disorder, there is reflux of acid-like bitter fluid/mucus manifesting as chronic recurrent vomiting; acidity symptoms and, occasionally, episodes of watery diarrhea. A 10 days' course of anti-H.pylori therapy will cure her problem. * Chaga's disease, a rare condition in Australia, which mimics the symptoms of your granddaughter. * Lastly, Achalasia cardia, a condition in which the primary disorder is of difficulty in swallowing of both: solids and liquids; occasional pneumonia, weight loss, chest pains etc.. to name a few. I suggest a simple test to rule out/confirm this condition : give her 1/2 tablet of isosorbide dinitrate (Isordil) thrice daily, 30 minutes BEFORE meals, for TWO days. If her vomiting stops, possibility of Achalasia cardia can be strongly considered. Irrespective of the cause of her problem, I strongly recommend that she be subjected to Endoscopy to establish the EXACT cause of persistent vomiting. Please ask her parents to consult her treating doctor and apprise him of my opinion/recommendations. I am certain that he will agree with my opinion and clinical acumen; order required tests, and- based on the reports- will arrive at a certain diagnosis and prescribe suitable treatment as advised. Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. IN ANY CASE, I AM LOOKING FORWARD TO THE ADDITIONAL INFORMATION AS REQUESTED. Fond regards and have a nice day, Dr. Rakesh Karanwal

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