13 yr old: nausea, vomiting, abdominal pain, dizziness 5 months

[Dale-Breidenbach]

  Our 13 year old son has had GI problems for 5 months, severe enough that he has not been in school all year.  Current symptoms include nausea in cycles of 1-2 days followed by 1-2 days feeling better (never 100%).  He's had all of the tests (3 colonoscopies/endoscopies, upper GI, ultrasound, 3 CT scans of head/abdomen, numerous blood tests, DNA test for Crohns, food allergy tests, bone scan, HIDA scan, etc).  The problem areas found were in the colonoscopies/endoscopies which showed inflammation and high eosinophils and the HIDA scan had an extraction rate of 19%.  Food allergy tests showed slight allergic reactions to wheat, milk, bananas.  The pediatrician and two pediatric gastroenterologists we've been seeing differ on their suspicions.  Because of the 19% extraction rate on the HIDA scan, our pediatrician and the surgeon he referred us to believe the gallbladder should be removed.  The gastroenterologists believe the eosinophils indicate food allergies which I find hard to believe would show up over night as this started.  He continues to be miserable and go through constant nausea with bad periods resulting in vomiting and gagging up air.  Any advice would be very much appreciated!
  Dale Breidenbach
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Dear Dale :
Your son may be unfortunate in having two conditions at the same time , a cholecystitis ( inflammation of the gallbladder ) and a hypersensitivity reaction of the digestive tract that maybe primary or secondary to other causes inducing the IgE immune system like allergies , parasitic infestations or granulomatous diseases.
Or he maybe dealing with one entity presenting itself in a vague picture initially only to evolve to a clearer diagnosis as time goes by .Eosinophilic gastroenteritis ( EG ) is an example of this and may link both conditions together ( i.e. ; the low excretion of the gallbladder and the GI tract signs ).
Eosinophilic gastroenteritis is a rare condition of unknown cause that mainly affects the stomach and small bowels ( rarely the entire digestive system , the gall bladder or extraintestinal organs ). The usual presentation is nausea , vomiting ( in  60-100% of the cases ) , diarrhea ( 60% ), sheets of eosinophils seen in small intestinal or stomach biopsies and peripheral blood eosinophilia ( 67% ). Eosinophils are the white blood cells that show up in the blood or locally in certain organs in response to a foreign agent the body has identified . These can be foods as in food allergy , pollens as in asthma , parasites as in intestinal infestations .
No specific foreign agent or antigen has been identified in EG . It can occur at any age , usually within the third decade of life , but infants as young as two months have been diagnosed with EG . Before diagnosing any case as EG , all other causes of eosinophilia have to be excluded , including food allergy, asthma , eczema , bacterial overgrowth in the intestine , parasitic infestations . I believe your gastroenterologist has reached this point in his management . An allergist may have to be involved to do some food elimination tests ( EG had been suspected in a reported case of egg and milk allergy ).
Regarding management of EG : a fair number of cases have responded well to corticosteroid therapy . Some trials of using mast cell stabilizers and or food elimination regimens have also been successful.
If you’re still not comfortable with the surgeon’s decision to remove the gall bladder , request a meeting where all parties involved get together and discuss the different possible causes of your son’s illness , the imaging studies and what they mean , the indications for removing the gall bladder , what to expect as a result of surgery , are there any postoperative complications ..etc.
Thank you for your question
Disclaimer : this information is for educational purposes only . Your physician is ultimately responsible for your health care , diagnosis and treatment.
Keywords : eosinophilic gastroenteritis