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Suggest Remedy For Persistent Abdominal Pain In A Child

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Posted on Sat, 9 Jan 2016
Question: My 6 year old daughter has been suffering Upper abdominal pains for the past 6 months. It severe in the morning and may ease off during the day. She has done blood, stool and urine test done with nothing found.

Then we when to a private hospital where there carried out more indepth test including ultrascan sound, Endoscopy and biopsy test. Still nothing was found. The abdominal pain is still there
doctor
Answered by Dr. Diptanshu Das (37 minutes later)
Brief Answer:
Gastroesophageal reflux or gastritis seems most likely

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have gone carefully through the mentioned details and understand your concerns. In such a case, clinical examination plays a very important role but that is beyond scope. Since you have already done the blood tests, I assume that the important possibilities have been ruled out. However, I would ask specifically if LFT (liver function test), lipase and amylase levels have been checked, and if so their values. I would also insisit you to upload any doctor's notes what could contain details of his clinical findings.

The most important possibility that seems likely in her case, is gastritis or gastroesophageal reflux and it is not necessary that it will reflect in the blood tests, ultrasonography or even endoscopy. I would insist on giving her Lanzol Junior (lansoprazole) once daily before breakfast. Talk to her doctor about the same. She also needs avoid long gaps between meals. If you feel that there could be an association with taking food, please mention.

Please mention about her bowel habits and the nature of her stool.

I will wait for your response so that I can help you.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Diptanshu Das (2 hours later)
Thanks for your answer.

First, I don't have the doctor's note or details. All the notes are with my GP. Just to let you know that we live in London UK.

All the the test result came back normal\negative with no single positive even allergies came back negative

Before my daughter went for the extensive test (scan, endoscopy, biopsy etc), the doctor prescribed Gaviscon which didn't help. After he prescribed LOSEC MUPS (omeprazole). It seem to help for a few days and the Upper abdominial pain came back again.

I don't think they sell "Lazol Junior" here in UK. Do you know of an alternative?

My daughter does suffer from any symptoms such as fever etc. Occasional feels like vomiting. She eats normal and snacks between meals in a day
doctor
Answered by Dr. Diptanshu Das (10 minutes later)
Brief Answer:
I still suspect gastroesophageal reflux

Detailed Answer:
Thanks for writing back and for explaining.

LOSEC MUPS (omeprazole) is almost identical to lansoprazole and should serve the purpose. I understand that it does not seem to help but still I would insist you to use it. Instead of once a day, you may try giving twice a day and see if it helps. I have strong suspicion that gastroesophageal reflux is the cause of her problems. In case of this ailment no tests may yield positive results.

Keep the gaps between meals small. Give small but frequent meals.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Diptanshu Das (18 hours later)
Hello Doctor,

Do you know the amount of LOSEC MUPS I should give her in a day?

Is this reflux related to H.pylori? Will antibiotics help?

I noticed in recent times, the upper abdominal pain comes in the morning and last around 1 to 2 hours then it stops for the whole day with very minor occurence until the next morning.
doctor
Answered by Dr. Diptanshu Das (58 minutes later)
Brief Answer:
Stomach acids are meant to help in digestion. Are secreted constantly.

Detailed Answer:
Thanks for writing back.

The dose of LOSEC MUPS (lansoprazole) depends upon the body weight of the child. If her weight is less than 30 kg, the dose required is 15 mg per day (dose is 30 mg per day for body weight greater than 30 kg).

H.pylori causes hyperacidity and gastritis and not merely reflux. Based on the description, reflux seems more likely. Gastric acids are secreted at a constant rate all throughout the day (and night). So, long gaps as in the night time lead to accumulation of good amount of acid in the stomach. This seems to be the cause of pain in the upper abdomen (where stomach is located) particularly in the morning, with minor occurrences at other times of the day. Antibiotics are unlikely to help. Rather, you need to follow the steps that I have mentioned.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Diptanshu Das (38 hours later)
Hi Doctor,

If this sympton is reflux, why didn't it show up in the Endoscopy test or the biopsy?
doctor
Answered by Dr. Diptanshu Das (6 hours later)
Brief Answer:
A reflux does not always cause visible changes evident on endoscopy.

Detailed Answer:
Thanks for writing back. The symptoms are likely to be due to reflux. Unless the reflux is severe enough to cause erosions of the mucosa it might not always be evident in endoscopy. A biopsy looks for certain other things including H.pylori and may not always yield conclusive results unless any definite pathology is present.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Diptanshu Das (1 hour later)
Another suspect after some googling is "Recurrent abdominal pain" may be "Abdominal Migraine".

The symptons I read points to "Abdominal Migraine". What do you think?
doctor
Answered by Dr. Diptanshu Das (1 hour later)
Brief Answer:
Abdominal migraine is a diagnosis of exclusion.

Detailed Answer:
Abdominal migraine is a diagnosis of exclusion. It is like when it matches nothing, you decide that it could be abdominal migraine. You can say that since the tests are negative, it could indeed be a possibility. But since the pain is specifically in the upper abdomen, the location of stomach, I have still felt that the possibility of hyperacidity and reflux could be the cause.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Diptanshu Das (1 hour later)
I've attached a picture showing the location of the pain. Is my finger at the nevus or upper abdomen?
doctor
Answered by Dr. Diptanshu Das (33 minutes later)
Brief Answer:
it is pointing to the upper abdomen

Detailed Answer:
Thanks for writing back. I have checked the attached image. Your finger is pointing to the upper abdomen and the location of stomach. It is not at nevus (unless you are obscuring it with your finger). A nevus means a birthmark or a mole on the skin, especially in the form of a raised patch.

Regards
Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Diptanshu Das

Pediatrician

Practicing since :2005

Answered : 3875 Questions

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Suggest Remedy For Persistent Abdominal Pain In A Child

Brief Answer: Gastroesophageal reflux or gastritis seems most likely Detailed Answer: Thanks for asking on HealthcareMagic. I have gone carefully through the mentioned details and understand your concerns. In such a case, clinical examination plays a very important role but that is beyond scope. Since you have already done the blood tests, I assume that the important possibilities have been ruled out. However, I would ask specifically if LFT (liver function test), lipase and amylase levels have been checked, and if so their values. I would also insisit you to upload any doctor's notes what could contain details of his clinical findings. The most important possibility that seems likely in her case, is gastritis or gastroesophageal reflux and it is not necessary that it will reflect in the blood tests, ultrasonography or even endoscopy. I would insist on giving her Lanzol Junior (lansoprazole) once daily before breakfast. Talk to her doctor about the same. She also needs avoid long gaps between meals. If you feel that there could be an association with taking food, please mention. Please mention about her bowel habits and the nature of her stool. I will wait for your response so that I can help you. Regards