What is your Diagnosis?

A month ago, our 13 year old son began having sharp pain all across his stomach, more intense on the right side, with diarrhea, vomiting, dizziness and nausea.  About every 36 hours he would have intense intestinal spasms for about 2 hours and crying from the pain.  He hasn't been to school since 1/4/05.  He has had blood tests, stool samples, 2 ultasounds, 1 x-ray.  He was admitted to the hospital on 1/22/05, after a 3 hour spasm which was intolerable.  They did additional blood work, endoscopy with a biopsy and a HIDA scan.  They apparently have ruled out gallbladder problems, virus, bacteria,appendicitis, liver&pancreas problems. They also have ruled out a food allergy. The found gastritis, no bacterial infection.  They also found that the food moves to slowly from the stomach into the small intestine and refluxes back into the stomach. This is all that they are able to diagnose and they are treating with the following medications : Carafate 10ML 4 x/day, Donnatal 16.2 mg - 1 tablet 4 x/day, Reglan 5 mg. 1 tablet 4x/day, Protonix 40mg 1 tablet every 12 hours. They tried numerous pain medications while he was in the hospital (morphine, toradol and nubain) none of them worked.  He was released from the hospital on 1/27/05.  He is still in extreme constant pain, the intestinal spasms are not as severe, but are still present.  He says the pain is worsening.  He is still having diarrhea, dizziness and nausea, and can barely walk.  He does not sleep through the night, due to the pain.  He has lost 11 pounds.  His diet consists of water, sprite, jello, bread, oatmeal, chicken soup and Boost.  It is particularly bothersome to us that this is the first time he has had an illness that he doesn't seem to be getting better.  We are reaching out because the pain is worsening.  We are questioning his diagnosis and treatment as he is not getting better.

[Kevin Pho, MD]

It sounds like a comprehensive exam has been done and would have ruled out most of the more serious diseases.  You mentioned an endoscopy with biopsy showing gastritis as well as a possibly slow intestinal pattern.  Many medications have already been tried.

If the tests continue to be non-revealing, you can consider irritable bowel disease - and possible antispasmodic therapy (i.e. Levsin or Bentyl).  

If there continues to be diarrhea, I would consider a lower endoscopy to evaluate for inflammatory bowel disease and colitis.  More specialized testing, including a fecal fat test, can be considered to look for malabsorption.

These options can be discussed in conjunction with a GI evaluation.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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