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Ask Dr. Yogindra Vasavada Your Own Question
Dr. Yogindra Vasavada
Dr. Yogindra Vasavada, Pediatrician
Category: Pediatrics
Satisfied Customers: 3187
Experience:  M.D.(ped) passed at first attempt, in practice continuously for last 37 years. Certi. in Comp
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Please only answer if you are very Exoerienced with GI in

Customer Question

Please only answer if you are very Exoerienced with GI in pediatrics... Long story short, my son's (13) pediatrician suspected IBD in my son mainly because of vague GI symptoms like frequent (2 times a day) floating stools, gas, nausea on and off. He was
also concerned because of poor weight gain and slightly delayed puberty. He ordered blood work (a year ago) that checked for things like CRP and other inflammation markers. All were normal. Then he ordered faecal calprotectin test that was elevated as 296.
I decided at that point to make changes in his diet and eliminated gluten and dairy from his diet. He actually gained some weight, but loose stools were still on and off without any obvious explanation. Most of the time the stool was well formed. 3 mo later
we repeated stool studies but added tests for infection along with the repeated calprotectin. Now it went down to 202. Still elevated, but better than it was. His GI wants him to go back on gluten and oerforn endoscopy/colonoscopy on him. My questions: 1.
Is this value high? The value is given in mcg/g and when I try to look at the ranges online, most of them are written as ug/g. Is there a difference? 2. From your clinical experience, would you suspect Crohn or other IBD? If so, is it typical for the value
to go down without any treatment? 3. He has been taking NSAID for the past three months... Could that influence the results? 4. He does have vague GI complaints, but I thought that true IBD would be more severe and. The value would not go down on its own.
Submitted: 1 year ago.
Category: Pediatrics
Expert:  Dr. Yogindra Vasavada replied 1 year ago.

Hello, Yes, ug/g is same as microgram/gram. High value at present does indicate bowel inflammation despite gluten/dairy-free and the nsaid he is on.

2) IBD is still possible. Crohn's would be more severe and more wt-loss, bloody stool etc.

3 nsaid may relieve some symptoms but may not cure basic condition. Calprotectin levels may fluctuate day to day or week to week for no apparent reason.

Good luck to him. Further tests like endoscopy may help.

Customer: replied 1 year ago.
What kind of IBD is likely?
Expert:  Dr. Yogindra Vasavada replied 1 year ago.

Mostly such children are labelled as indeterminate IBD and later on, it may turn out to be crohn's or ulcerative colitis. Wheat may be allowed as refined flour if there are no antibodies against gluten in blood.

Please try to maintain good caloric diet with less roughage (salads etc), simple cereals like rice, antispasmodic like dill water and baby gripe mixture SOS for abdominal cramps.

link : http://www.pedsibd.org/parents/nutrition.html

Customer: replied 1 year ago.
If it was Crohn or ulcerative colitis, would calprotectin just go down on gf diet?
The first test of 295 was done three months ago and this one just now is 202. Did not it go down by a lot? Is it typical of Crohn? The range that the lab sent I'd below 169 buy what I read online it should be lower.
Expert:  Dr. Yogindra Vasavada replied 1 year ago.

Suggested cut off level for this test is 50 mcg/g and some variation can occur on its own. There may be no relation to elimination diet.

Customer: replied 1 year ago.
The lab values say below 169 is normal.
Do you think it is necessary to do colonoscopy? Are there need for IBD? Are they life long or are taken as needed?
Customer: replied 1 year ago.
I meant are there medications for IBD? And if they are taken all life or as needed? Do most people achieve remission when they don't need to take medications?
Expert:  Dr. Yogindra Vasavada replied 1 year ago.

A look at colon mucosa and extent of such lesion can be graded by scopy. Medications help relieve symptoms and lead to weight gain. During natural remissions there may be less need of such medications so can be taken intermittently. There is fair chance of long remissions and even cure of this condition with growth and maturity.

Customer: replied 1 year ago.
By remission you mean no medications, right???
Expert:  Dr. Yogindra Vasavada replied 1 year ago.

No medication, or reduced dose (due to much alleviation of symptoms and signs).

Customer: replied 1 year ago.
Thank you. He also started complaining of sharp pain in the upper stomach right before he eats and while eating. It seems to get much better when his stomach is full. That has been going on for the last couple of days. Does that make any sense? What condition are you leaning towards?
Expert:  Dr. Yogindra Vasavada replied 1 year ago.

You are welcome. This is like acid peptic disease, stomach upset with over-secretion of hydrochloric acid. Please give bland diet, plenty of fluids, maalox syrup every 3-4 hours, aciloc (renitidine) 150 twice daily and see. Please consult your doctor afresh.

Customer: replied 1 year ago.
Could this be caused by NSAID? How does calorotectin fall into the picture?
Expert:  Dr. Yogindra Vasavada replied 1 year ago.

Yes indeed. Please stop few days. Calprotectin has no relation or bearing to this new symptom.

Expert:  Dr. Yogindra Vasavada replied 1 year ago.

Please evaluate the responses positively. Thanks.

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