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What Causes Diarrhea With Vomiting?

Posted on Thu, 5 Jun 2014

Question: Hello: I am writing in regards to my 15 yr old son who has chronic issues with various stomach problems. He had a problem on and off for months with feeling sick in the night, not being able to sleep and then being a limp rag the next day. Our physician diagnosed it as GERD and put him on Nexium and it cleared up. (He wanted to do a barium swallow in fact was quite adamant but I said no since Nexium was working) Then a few weeks later he had diarrhea that was not severe but it hung on for several weeks, on and off. Now we are dealing with vomiting. He throws up only about once at night and then again in the morning (this lasted for 2 days, gone 2 days back for 2 days). THroughout all this, he complains of stomach cramping (while having D or throwing up issues). I have not gone back to our Dr. since I think he is mad at me for not getting swallow. I also think all this is so random that it might be related to diet. He is a BIG kid- 6'4", 200 pounds so it isn't like he is starving or anything like an eating disorder. My sister in law belives he might do well going gluten free. Another person said lactose intolerance (he does love yogurt and milk) and yet another says parasites but I don't see that at all. I have started a food log to try and track things and for now we are trying to go gluten free but I have no idea before that kicks in. As far as any other symptoms, he occasionally has headaches and sometimes says that when he stands up too fast it goes black. I told him that happens to all kids who play xbox too much. lol (He plays a little from time to time, he is not bad like some kids are!) I need ideas please.

Answered by Dr. Sumanth Amperayani (6 hours later)

Brief Answer:
Irritable bowel or inflammatory bowel disease

Detailed Answer:
Hi...thank you for consulting on Health Care Magic. I appreciate your concern regarding the vague symptoms of your kid. With his stature & good built, as you have rightly pointed out I too think this is not an eating disorder. But putting one and one together, 2 possibilities come to my mind -
1. Irritable bowel syndrome
2. Inflammatory bowel disease (Crohns or Ulcerative colitis)
I would not think of GERD when he's having diarrhea along with vomiting...isolated vomiting & heartburn I agree..but not when diarrhea is there. Coming to the possibilities I suggested, these two can start at any age and are notorious to be diagnosed very late as there should be a high index of suspicion when considering these. As you suggested gluten free diet, I assume you are considering celiac disease but its rare presenting this far (15years) that too in a well built child. But for confirmation you can get a tissue transglutaminase antibodies done. Inflammatory bowel disease requires early endoscopy and colonoscopy along with a biopsy. The only thing which is not fitting in is occasional blackouts. I suggest, even if your physician is mad, kindly approach him & discuss about the possibilities I put forth, for kid's sake. I wish your 15 year old good health & speedy recovery. Hope my answer was helpful for you. Happy to help anytime. Further clarifications and consultations on Health Care Magic are welcome.
Dr. Sumanth MBBS., DCH., DNB (Paed).

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Sumanth Amperayani (20 hours later)

Thank you for your response. I am not trying to be unreceptive, I am just trying to sort all the possibilities. I honestly do not think it is bowel related because he has indigestion/queasiness/headaches/nausea far more than he has diarrhea. When he does have diarrhea, it is mild. I don't think it is as severe as celiac disease either. Could it be an obstruction of some sort? Hiatal hernia? Of course, with those, it would be ongoing instead of random, correct? This is what again leads me to wonder if it is diet related. I spoke to our old pediatrician and she suggested a food log which I actually started last week. I do know that he had ice cream one night and early morning threw up. Gall bladder? I am proceeding with the food log. I know that this website is not the end all solution but I like having someone knowledgeable to bounce ideas off of. Thank you.

Answered by Dr. Sumanth Amperayani (5 hours later)

Brief Answer:
Ruling out treatable conditions shoud come first

Detailed Answer:
I thank you for your trust in me. I agree with you that food related is a probability. But one logical train of thought is that if food is the only cause then, he should be having the same food ingredients since long and he is well built kid, which rules out conditions like malabsorption. Keeping a diary of 24hour or weekly dietary recall is a very good idea. But my concern is the same as you.

The vagueness of the symptoms are the ones which are worrying me too and in my experience I have seen till now 5 cases of Inflammatory bowel disease presenting vaguely and being diagnosed after endoscopy and biopsy. When I went through the literature, I stumbled upon innumerable references in medical literature saying the lack of high index of suspicion is what is the main cause of late diagnosis and complications is such cases.

I again humbly suggest you to consider this possibility and discuss with your pediatricians about the possibility of probing in these lines.

I wish your son a very bright future and speedy recovery. I also request you one thing....I am really interested to know as a physician what is the final outcome and diagnosis after which your son got better. I request you to share this with me so that this experience will help some other kid whom I see with same symptomatology.

With kind regards - Dr. Sumanth MBBS., DCH., DNB (Paed).

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Above answer was peer-reviewed by : Dr. Prasad