Any advice?

[Misty1982]

Hi there. My 5.5 year old has had persistent gi issues since the beginning of April. He got very sick for 2 weeks with what our family doctor and the ER doctor determined to be gastroenteritis and colitis. His stool samples and labs all looked ok but he had bloody diarrhea, a fever for a couple days in the beginning of the illness, severe pain, and became dehydrated.

We worked hard to restore his gut health with diet and probiotics but he hasn't been healthy since he got sick. He frequently has mucousy stools that constantly vary between diarrhea and constipation. His stool is frequently pastel/pasty in color and he has a lot of tummy pain.

We recently re did his labs in mid June and he had a positive lactoferrin test and his blood indicated some food allergies including wheat so we eliminated gluten from his diet.

9 days ago he passed blood again. Since then he has been exhausted and has taken multiple naps each day. Today he passed blood again.

The blood has always been bright red but it is in the stool, tints the water, and I can see it when he wipes. When he was sick in April he passed all blood and mucus once.

Our family doctor began working on a referral to a pediatric gi specialist today but I thought I'd see if anyone had any thoughts or advice.

Thanks!

 

[crohnsinct]

Definitely sounds like he needs a pediatric GI.

Positive lactoferrin can be caused by gastro infection, celiac, NSAID use or IBD (also diverticulosis or colon cancer but in a child so young that is not likely) so it is hard to say. IDK a lot about lactoferrin as most GI's are using fecal calprotectin these days and this test comes with an actual value rather than positive or negative so I would rather get this test done.

It sounds like your son certainly does need a full work up by a ped GI which will probably include upper and lower scopes and probably MRE.

Mucus is common with bowel inflammation but is also common with IBS and small intestinal bacteria overgrowth although these two conditions do not produce bleeding or raised lactoferrin. Also, going between diarrhea and constipation is also very indicative of both these conditions. Also, with severe rectal IBD inflammation one could go between diarrhea and constipation and produce both blood and mucus.

Bleeding gets tricky as things like fissures and hemorrhoids could also produce some bleeding and bleeding with severe gastro infection is not uncommon. However any on going bleeding in a pediatric patient especially with raised lactoferrin should be suspect.

Hold on. You are at the beginning of this journey. The road to diagnosis with GI conditions could be long and takes many turns.

Good luck at the GI and if you have any questions we are here for you.

I might ask the ped to run a fecal calprotectin test as those results can take a week to get and there is a pretty definitive cut off value at which GI's will move to scopes suspecting disease of an organic nature (Celiac, IBD) as opposed to functional (IBS). If you have this result before going to the GI it will help move things along a little more quickly.

 

[Misty1982]

Thanks so much for sharing your thoughts and encouragement. It's been a long few months and I'm thankful we are connecting with a gi and look forward to getting some answers.

 

[Cross-stitch gal]

I'm not saying he has it, but it kind of sounds like Ulcerative Proctitis. It's a directed diagnosis specifically in the anal area, and is a version of Ulcerative Colitis. I was diagnosed with this and had/have the same symptoms. I totally agree that a GI should informed. Good luck. :hug:

 

[Maya142]

It's hard to tell what it is without testing - I'm glad you have been referred to a pediatric GI.
But while you are waiting, has his pediatrician or GP tested for anemia? Given the blood in his stool, he could very easily be anemic and that could account for the exhaustion.

Like has been said above, they will likely test for infections and if those are negative, then they'll probably do upper and lower scopes to look for IBD or Celiac.

If infections have already been ruled out (through stool tests), then I'd see if your pediatrician can do a Fecal Calprotectin, like crohnsinct said above. That will tell you if there is inflammation in his gut and it might speed up the process - get you into a ped. GI sooner.

If he has high fever, is in severe pain or is passing a lot of blood, I would not hesitate to take him to the ER.