Suggest treatment for abdominal pain

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Posted on Tue, 4 Nov 2014 in Digestion and Bowels
Question: Hello DR.
My son has growth issues and D and abdominal pain (15 years old, 5'5" and only 88lbs) so we got the gastroscopy and endoscopy done for him overseas as we had difficulties getting an appointment here. Those were negative but the biopsy was different. The results were the following (excuse the translation):
1. exam of parts the mucousal membrane of the small intestine where the villus are a bit shorter, wider but with kept sections.
aggregates of lymph nodes containing secondary lymphoid follicles can be seen
crypta/vili ratio is normal
Intraepithelialis lymphocytosis is not typical
In the lamina propria there is minimal Lymphoplasmacytic cellular infiltration/leak with mild eosinophilia
2. Colon mucous membrane:
Crypts are normal
In the laminal propria lymphoplasmacytic cellular infiltration/leak can be seen together with eosinophil granulocytes
Neutrophil granulates can also be seen that get under the crypts
In a small piece of tissue primary lymphoid follicles can be seen in a narrow fat tissue below the muscularis mucosae
In another cross-section secondary lymphoid follicles can be seeen in the the lamina propria

3. colon
mucousal membrane of the large intestine.
In the laminal propria eosinophil granulocyte are more defined in some places, 40 granulocytes were counted in large magnification

4. exam of villi in the small intestine with some crypts typical to duodenum.
In the laminal propria Lymphoplasmacytic cellular infiltration/leak can be seen together with eosinophil granulocytes.
In some areas 1 lympocyte to 10 entrocytes is visible

On top of these findings 2 months ago, a few weeks ago he started having lots of pain in his chest. Nausea, felling like blockage in his throat, chest pain, burning sensation followed. He was prescribed Omeprazole (due to GERD?) but I am not sure if it helps.
He has appetite but is having diffculties swallowing so started eating less but is not losing weight yet.
His blood results are:
WBC 4.8 RBC 4.47 HMG 134 HMC .39 MCV MCH 30 MCHC 246 Neutrophils 1.4 lymphocytes 2.5 monocytes .05 eosnophils/basophils/granulocytes 0 ferritin 14 iron 11 tibs 67 %transferrin .16
He seems to have energy still (middle distance runner) but he looks like a skeleton. No muscles in arms.
B12 299 C-Reactine .7 IGe 849
He has lots of D. He doesn't seem to digest fat at all. After hydrogen breath test yesterday he had watery D.
We are very concerned he is not gaining any weight and his iron level is low. We were thinking of giving him iron supplements but not sure whether it is a good idea. Waiting for a doctor's appointment but the overseas doctor suggested we start him on budesonide as he has active inflammation. We are not sure if this is Chron's or maybe some kind of eosonophilic gastroenteritis as he doesn't respond to the PPI.
Thank you for looking at this and your opinion is very much appreciated.
doctor
Answered by Dr. Arun 6 hours later
Brief Answer:
eosinophilic gastroenteritis

Detailed Answer:
Hi
Thanks for writing to us.
The biopsy report and history look more like eeosinophilic gastroenteritis.
Yes he has low iron levels too.
You need to start steroids as soon as possible. Allergy testing will be required to identify the trigger factors in diet. The identified items by skin prick test need to be avoided.
These two steps are the initial measures I would recommend.
Start iron supplements along with folic acid.
Do consult your pediatric gastroenterologist and discuss these with him.

Wishing your child good health.

Regards
Dr Arun
Above answer was peer-reviewed by : Dr. Yogesh D
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Answered by
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Dr. Arun

Pediatrician, Pulmonology

Practicing since :2003

Answered : 1869 Questions

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