6 year old w/ chronic diarrhea...no diagnosis

[jenybeen]

I have a 6 year old son who has had diarrhea since as long as I can remember.  We've switched pediatricians, been to 2 pediatric GI doctors, and we're not getting any answers.  My son is very short for his age, he is the height and weight of the average 4 year old.  I have 3 other children, and they're all fine.  We've ruled out Crohn's, Celiac, Cystic Fibrosis, and tons of other things.  Numerous blood tests, a colonoscopy and 2 endoscopies.  I am so sick of seeing him in pain and wasting away.  He has anywhere between 2 and 6 bouts of diarrhea per day.  He also gets back aches and lately he's been complaining of what seem to be muscle spasms.  They do know that he has some sort of malabsorbtion problem, and he's on Creon (to help aid in digestion of fats and protein).  I hate to medicate him when I don't know exactly what it's for.  

I keep thinking maybe we're looking in the wrong place...maybe it's his kidneys or gall bladder or a genetic condition?  What do you all think?  Where should we go?  Anyone have an experience like this with a child?  Thank you for any advice or suggestions!  

Jennifer

[boron]

I think you are not getting enough information from doctors.

Creon is a mixture of pancreatic enzymes, and it is maybe given because pancreas is not working properly. In this case, blood test for pancreatic enzymes, and pancreatic function tests would show reduced pancreatic function. There is not a lot of mistery here, pancreatic function is normal or not; if it is normal, it is not likely that the cause would be pancreas, and if it is abnormal - well then an exact cause still has to be found, but you may assume that the cause is pancreas.

I don't know, if they prescribed Creon on the basis of pancreatic tests, or just like some trial. Creon may be prescribed also in intestinal disease with malabsorption, to help with absorption, mainly of fats. You should ask for appointment and demand exact results of any pancreatic tests and for their explanation.
http://www.drugs.com/pdr/creon.html

Back pain - if it is on the sides, just under the rib cage, it may be from kidney(s). Urine test may give a lot of information about kidney, but I would stick with gastro investigations for now.

MALABSORPTION may be due to:
1. liver, not producing enough bile (due to any liver disease). Stools (diarrhea) would be pale, whitish, foul smelling, foamy, sticky.
2. gallbladder disease (stones, inflammation) itself can not result in malabsorption. If a stone is lodged in the bile duct, it prevents bile flow into intestine, and causes symptoms like above, plus strong cramping pain under the lowest right rib. Diagnosis: first ultrasound, then HIDA scan.
3. pancreatic disease. If pancreas does not delicver enough enzymes into intestine, food will not be absorbed properly, what results in diarrhea. Diagnosis: pancreatic function tests.
4. Small intestine: any small intestinal disease can cause malabsorption. Celiac disease and inflammatory bowel disease (Crohn's disease) are most often. Lactose intolerance would cause only diarrhea and not problems with growing, I guess. Some rare genetic diseases are possible, where some particular digestive enzyme (normally produced in small intestinal wall) is lacking.

WHAT TO DO:
Check what pancreatic tests were done and what are exact results. I would really stick with gastro causes for now. Muscle cramps may be from malabsorption of vitamin B or folate or potassium - well, this should be obvious from blood tests.