A Child with Burping and Abdominal-Chest Pain

1/20/2008

I was asked to evaluate a 10 year old child who has been having severe burping and pain in her upper abdomen and lower chest. I initially sent off blood work for a variety of tests including wheat intolerance (Celiac Disease) and Helicobacter Pylori (H. Pylori bacterial infection of the stomach).

All blood work was negative with the exception of an elevation of the eosinophils in the CBC (clinical blood count). These cells are sometimes indicative of an allergic tendency. The young lady was advised to do an elimination diet by cutting out one major food component at a time and keeping a diary noting how she felt every day. After going through milk, wheat, eggs, corn, and soy separately one week apart she noticed no change. She was also given a prescription for Prevacid which definitely improved her symptoms. I had her see a pediatric gastroenterologist due to the duration and severity of her complaints.

After monitoring her for several weeks, both the gastroenterologist and I agree that an upper endoscopy is indicated in view of the difficult symptoms and their persistence. What are we looking for? There is a condition called Eosinophilic Esophagitis which causes GERD (gastro esophageal reflux disease) type symptoms. This condition is suspected to be allergic in nature and thus merits a further and more extensive allergic workup. This diagnosis can only be made by a tiny biopsy done during the procedure.

      

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