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Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 47527
Experience:  Board Certified Physician
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My 13.5 year old son has been diagnosed with reflux oesophagitis

Customer Question

My 13.5 year old son has been diagnosed with reflux oesophagitis in April , Priior to that he had a diagnosis of RAP for which he was treated with amitriptyline and mebeverine. Successful for about 5 mnths then flared up Had upper and lower endoscopies in April that confirmed diagnosis. given lansoprazole which severely exacerbated symptons of nausea and abdo pain as it had done the previous year when GP diagnosed gastritis. GI specialist took him off it after 2 months. Also had same neg reaction to Omeprazole. GI Dr seems ot have given up. son now back on mebeverine and amitriptyline at my request with little effect - just desperate to get him some relief. Also on melatonin 4mg which helps a bit -syjptoms impact on sleep. Has seen CBT therapist for guided imagery had psychological help to help him deal with discomfort - missed a lot of school. Now trying reflexology Restricted diet as test by nutritionist said he was sensitive to wheat gluten dairy corn and yeast. Avoids obvious triggers like choc, mint, fizzy drinks citrus. Is really fed up - nausea most trouble some symptom. Gets a bit constipated and has Aspergers (Mild) = no LD or behavioural problems. Have moved him to a closer and less pressured school. AFter a year plus of this son less compliant and really fed up. I have tried a really holistic approach and nothing helps. He is now getting into school although this is an almighty struggle. Don't think symptoms are anxiety related as suffered on holiday and at Xmas when very happy.
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. David replied 3 years ago.
Dr. David :

This is Dr. David

Dr. David :

has he been tested for H Pylori bacteria in the stomach?

Customer:

yes. Came back negatve. Also I took him to a nutritionist who tested for food sensitivities and found wheat gluten dairy yeast corn intolerant. I know the science behind Igg test is doubtful but anyway I have kept him off these things and followed the normal advice about citrus tomato etc with no effect either way

Dr. David :

he should get a barium study and a stomach emptying study to make sure food is moving out of his stomach.

Dr. David :

he could be having gastroparesis or lack of motility of his esohpagus and stomach.

Customer:

He had lower and upper endoscopies done where they pumped air in. Would this have shown gastroparesis?

Dr. David :

no,

Dr. David :

endoscopy just looks inside of the stomach and esophagus.

Dr. David :

it does not look for function and motility.

Dr. David :

and does not check for gastroparesis.

Customer:

Biopsies were taken.

Customer:

Also GI specialist works at prestigious hospital and has 30 years experience. I am not asking you to comment on his practice but would motility be something that might have been an obvious thing to check?

Customer:

Would gastroparesis be something that coexists with oesophagitis?

Dr. David :

yes, it can

Dr. David :

it is rare in children, but I think it is rare to have reflux at his age.

Dr. David :

so rare things needs to be checked.

Dr. David :

we tend to see gastroparesis in older patients who have nerve damage to their stomach

Dr. David :

like diabetic patients who have nerve damage

Dr. David :

and the nerves which tell the stomach and esphagus to move don't work.

Dr. David :

but it would be going on in him as well.

Dr. David :

let me know if you have other questions.

Dr. David :

talk to his GI doctor about motility testing

Dr. David :

and testing for gastroparesis

Dr. David :

which can cause nausea.

Customer:

How is gastroparesis treated? Would that be the reason why amitriptyline helped> Though not sure why it stopped being effective

Dr. David :

yes

Dr. David :

the nerves might not be working correctly to move the stomach contents.

Dr. David :

there are pro motility medications like reglan which could help

Dr. David :

or other nerve medications like neurontin (gabapentin) which could help.

Customer:

What could cause gastroparesis in an otherwise healthy non diabetic child? Why do medications stop working? ie the amitriptyline.

Dr. David :

amitriptyline is an old tricyclic antidepressant which is sometimes used for neuropathic pain or nerve related conditions.

Dr. David :

but it is really an old antidepression medication

Dr. David :

it is inexpensive, so some doctors try it to see if it helps nerve related issues or nerve pain.

Dr. David :

I don't know why he would have gastroparesis.

Dr. David :

but he should be tested for it to be sure.

Dr. David :

it could be from his constipation possibly

Dr. David :

or why he also has constipation as well

Dr. David :

or could be from his mild aspergers possibly.

Customer:

What is the test for gastroparesis? Would a doctor try a pro motility med like reglan without clear diagnosis?

Dr. David :

I don't know what his doctors will do.

Dr. David :

it is a stomach gastric emptying study which uses fluoroscopy

Dr. David :

which uses xrays and radiation.

Dr. David :

so his doctors may not want to do it.

Dr. David :

they could just try the reglan and see if it helps.

Customer:

Many thanks

Dr. David and 2 other Medical Specialists are ready to help you
Customer: replied 3 years ago.

I have been back to consultant regarding intractable nausea . He has basically said that there is nothing else medically that they can do. He has suggested raniditine again - although that did not work in the past and continuation of amitriptyline. He thinks my son's problems are psychosomatic in origin. I do not. Should I get a second opinion?

Expert:  Dr. David replied 3 years ago.
yes, you should get a second opinion

and you should get your son seen by a child psychologist or child therapist as well

to see if there is something else your child is objecting too possibly by having these nausea and vomitting symptoms.