My nephew's GI symptoms

[CarolinAlaska]

My sister's boy, about 22 years old, has been having severe nausea for about 3 weeks with vomiting if he tries to eat. He is having both constipation and diarrhea. He has lost 12 lbs. He had an EGD which showed severe gastritis and some ulcers and a diverticula in his stomach (is that common? I've only heard of it in colons). He denies blood in his stool. He is on proton pump inhibitor twice a day, sucralfate four times a day (and told not to eat 1.5 hours before or after it - really?), Ensure about twice a day, and zantac with each meal. He's been using milk of magnesia for constipation and that seems to lead to profuse diarrhea. After the EGD, the doctor told him to continue same meds and follow-up on Tuesday for biopsy results, but said it was likely "a bad virus". Really? Three weeks of this, ulcers, diverticula, nausea and vomiting, constipation and diarrhea - a virus?

Do you think he could be developing Crohn's like his cousin (my daughter)? He is not aware of any sed rates or CRPs.

 

[my little penguin]

DS had it in his upper Gi track - which included vomiting and nausea .
Did they do any imaging studies of the lower Gi tract ? Or fecal cal ?
Blood work ?

 

[CarolinAlaska]

Well, I had all those questions too. He doesn't know of any tests they did on the blood except CBC and basic chem (these done in ED). He's supposed to be getting a stool specimen, but they didn't give him a hat, just a couple sticks and a couple vials to collect into, but he's having diarrhea Hard to get samples of that with those little sticks. He doesn't know what they plan on testing with the samples... I forgot to mention that this young man suffers terribly with back and knee pain too, long before the abdominal symptoms. He has degenerative arthritis in both - and at such a young age.

 

[DustyKat]

Do you think he could be developing Crohn's like his cousin (my daughter)? He is not aware of any sed rates or CRPs.

Based on what you said Carol, Crohn's is something I would at the very least want ruled out.

I say that coming from the perspective of my children's initial presentations, both of which had upper GI symptoms...

Sarah: was not a classic presentation in any way, shape or form. No diarrhoea or blood. Epigastric pain that was cyclic until the intervals became more and more frequent and eventually constant. Headaches accompanied these episodes with nausea and vomiting. Eye pain and knee pain.

Matt: diagnosed super quick, Sarah's legacy no doubt. He had one week of mild symptoms. He too had no diarrhoea or blood. It started with a couple of random vomits one night, then 6 days of being off his food, followed by another night of vomiting. That was it. I asked for serum inflammatory markers to be done and CRP was raised. They repeated bloods the following week and it was further raised. At that point the GP could feel a mass in his RLQ and stated there and then he thought he had Crohn's. It was confirmed within a week via scope.

It is not at all uncommon for the EIM's of IBD to appear well before the intestinal manifestations do.

Dusty. xxx

 

[CarolinAlaska]

Based on what you said Carol, Crohn's is something I would at the very least want ruled out.

I say that coming from the perspective of my children's initial presentations, both of which had upper GI symptoms...

Sarah: was not a classic presentation in any way, shape or form. No diarrhoea or blood. Epigastric pain that was cyclic until the intervals became more and more frequent and eventually constant. Headaches accompanied these episodes with nausea and vomiting. Eye pain and knee pain.

Matt: diagnosed super quick, Sarah's legacy no doubt. He had one week of mild symptoms. He too had no diarrhoea or blood. It started with a couple of random vomits one night, then 6 days of being off his food, followed by another night of vomiting. That was it. I asked for serum inflammatory markers to be done and CRP was raised. They repeated bloods the following week and it was further raised. At that point the GP could feel a mass in his RLQ and stated there and then he thought he had Crohn's. It was confirmed within a week via scope.

It is not at all uncommon for the EIM's of IBD to appear well before the intestinal manifestations do.

Dusty. xxx

That is what I'm afraid of. Perhaps Jaedyn's Crohn's will help him get diagnosed earlier. Do you think that adult GIs see fewer Crohn's patients and diagnose it less? Is it harder to diagnose in young adults? Is it not even in the scope unless someone has been suffering symptoms for a month or more?

 

[DustyKat]

Do you think that adult GIs see fewer Crohn's patients and diagnose it less?


I'm not sure Carol. I do think though that the scope of presentation is so wide that unless you they can pigeon hole you then it is often overlooked.
I agree that in a GI practice the number of IBD patients compared to the overall demographic would not be large. This is evident when in the waiting room of the GI we see and was also glaringly apparent when Matt was in the colorectal ward. We were fortunate that he was Sydney so there were a couple of IBD specialists on the team.

Is it harder to diagnose in young adults?

I don't think it is any harder to diagnosis per se but again I do feel it boils down to varied presentations and even the lack of evidence on testing, as was the case with Sarah. It has certainly made me very wary of the dependence on clinical evidence at the expense of what is staring you in the face.
I do feel that there is a general lack of awareness of IBD in the medical community.

Is it not even in the scope unless someone has been suffering symptoms for a month or more?

I certainly don't think it would the first thing they look to and I don't think it is unfair of a doc to say 'bug' when someone first presents with diarrhoea and vomiting but it would be nice if the whole picture was looked at the consequent presentations of continuing symptoms rather than it being repeatedly dismissed.

Dusty. xxx

 

[CarolinAlaska]

I just have a really hard time when they know he has a family history of crohn's. He is doing fine - no viral symptoms at all - then he eats and wham! he gets terrible pain and vomiting. This starts out of the blue and nothing helps for 3 weeks. He can't eat anything and weight is dropping off left and right, he starts getting diarrhea a couple weeks later. Then they just call it "virus". I'm telling you, that doesn't sound like any typical virus I've ever heard of. Aren't you listening doc? This is NOT normal! Viruses don't cause vomiting for 3 weeks without fever, headache, body aches, etc. Tell him you don't know what it is, but don't minimize it until you can figure it out!

I hope they can find a diagnose that will help him with his joints too. This kid has been suffering for far too long.

 

[DustyKat]

Inflammatory bowel disease (IBD) should be suspected in any patient presenting with chronic or recurrent abdominal pain and diarrhoea.

http://www.smw.ch/content/smw-2012-13557/

I hear you Carol and agree...^^^^this surely sounds like your nephew to me. With his symptoms, including weight loss!, coupled with his family history then it is remiss of them not to be ruling IBD in or out.

Dusty. :heart:

 

[Catherine]

Different presentation again with my Sarah, attacks of so called gasto, lasting for 24 to 48 hours, severe pain no vomiting no diarrhoea, time between episode decreasing each time. Worsing anemia.

At time of dx Sarah inflammation had already become chronic. As per our GI severe pain without vomiting or diarrhoea is not gasto.

She has never seen another case like Sarah, but the practise head had.

 

[CarolinAlaska]

Update: Logan is still vomiting with eating, has terrible abdominal pain upon awakening. Had one normal stool last week (was very glad). All the GI tests have been normal (scopes, ultrasounds, CT scan, barium swallow). GI thinks it might be stress and has him trying Librax. As of Friday, he was still vomiting. I'm not sure, but I think he may still be on back pain meds (opioids), which I've encouraged my sister to encourage him to get off of for at least 2 weeks to see if it helps his GI problems... sigh.

 

[xmdmom]

What do his doctors think caused the gastric ulcers? Most common causes are NSAIDS or H Pylori. Without any temperature, a virus seems unlikely.

Weight loss is a red flag and although stress can do it, you'd want to rule out other things first unless there was a new obvious stressor or psychological issue. Has his weight stabilized?

 

[CarolinAlaska]

I don't know, but I don't think he has much more weight to lose. He is a tall thin athletic boy to begin with . I wish I could look over all his results and go with him to his next appt! Sometimes it sucks living so far away!