Gastrointestinal Concerns in a Young Patient
A five-year-old Caucasian boy has been experiencing issues with soiling that began approximately six months ago. Following a thorough examination, he was diagnosed with encopresis along with chronic constipation, raising concerns about a possible case of celiac disease. laboratory tests revealed a deficiency in IgA, alongside elevated levels of DGP-IgG at 8.04 (with a reference range of 0 to 4.99) and an AST level of 49, aligning with suspicions regarding celiac disease. An endoscopic evaluation showed mild localized scalloping in the duodenum, which further heightened the concern for this condition. However, a biopsy taken was found to be within normal limits. The gastroenterologist has ruled out celiac disease and has suggested maintaining a regimen of laxatives and fiber. Now, the question arises: Should we consider seeking a second opinion or perhaps initiate a strictly gluten-free diet? Additionally, would ordering an at-home genetic test provide further clarity? Insights on this matter would be greatly appreciated.
Answers (1)
8/28/2025, 4:45:28 PM
OpenHealth AI
It seems you're understandably concerned about your son's gastrointestinal issues, particularly given the complexity of his symptoms and the initial findings suggesting celiac disease. Here’s a breakdown of the situation and what you might consider next.
Main Points
- Your son has been diagnosed with encopresis and chronic constipation but has been cleared of celiac disease based on biopsy results.
- The gastroenterologist has recommended continuing with a regimen of laxatives and fiber.
Explanation
Encopresis, often linked to chronic constipation, can be both physically and emotionally challenging for a child. The presence of elevated DGP-IgG and slight duodenal scalloping raised initial concerns for celiac disease, but the normal biopsy results are reassuring. Celiac disease is a serious condition that requires a strict gluten-free diet, but since this has been ruled out, you may need to focus on managing his constipation and the associated symptoms.
Next Steps
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Follow the Gastroenterologist’s Advice: Continue with the prescribed laxatives and increase dietary fiber. Encourage water intake to help soften the stool. Foods high in fiber include fruits, vegetables, and whole grains. This step is crucial in managing his encopresis.
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Monitor Symptoms: Keep an eye on his bowel habits, noting any changes in soiling incidents, abdominal pain, or other gastrointestinal symptoms. This can provide valuable insights into how well the current management plan is working.
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Consider a Second Opinion: If you are still concerned about the diagnosis, especially regarding his initial testing and symptoms, seeking a second opinion from another pediatric gastroenterologist can be a good step. They may offer additional insights or different management strategies.
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Gluten-Free Diet Consideration: Before initiating a gluten-free diet, it's important to confirm celiac disease through appropriate tests and biopsy, particularly as gluten withdrawal can complicate further diagnosis. If his symptoms persist or worsen despite treatment, this may warrant further investigation.
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Home Genetic Testing: While at-home genetic tests for celiac disease can provide some information, they typically only indicate genetic predisposition and can’t confirm or rule out celiac disease on their own. It might be more effective to consult with a healthcare provider to discuss the relevance and importance of genetic testing in your son's case.
Conclusion
Encourage dietary changes, maintain the current treatment plan while monitoring symptoms, and consider professional guidance for any concerns about further testing. Your proactive approach is key to finding solutions and providing relief for your son.
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