Hello everyone,
Back in February of this year, I posted to the list the case presentation
of my then 13 month old daughter, who had failure to thrive. Here is the
link to my presentation:
http://peach.ease.lsoft.com/scripts/wa.exe?
A2=ind0202C&L=lactnet&P=R2716&D=0&H=0&O=D&T=1
and:
http://peach.ease.lsoft.com/scripts/wa.exe?
A2=ind0202C&L=lactnet&P=R5329&D=0&H=0&O=D&T=1
I wanted to update everyone on the case.
I continued to bf. We continued to try all sorts of different solids, and
fatty foods. At her follow up, a month later, she gained 9 oz. This was
not good enough for GI doc, who was hoping to see more gain. She asked if
I had weaned, and dropped the subject when I said that I had not because I
did not think it had anything to do with it. She did more blood work:
IgA and TTG to test for celiac disease: neg
Repeated liver function tests: neg
RAST for food allergies: neg
Scheduled us for sweat test to rule out cystic fibrosis (she is of
Black/Asian ethnicity so no one really thinks she has CF but it gives us
something to do)
Wrote prescription for empiric trial of Zantac—not tolerated well by my
baby due to disgusting strong peppermint taste. Continued on zinc
supplement, well tolerated.
Follow up in 3 months. However, in the next six weeks, my baby came down
with gastroenteritis and lost more weight. She did regain what she lost
but not more than that. GI doc wanted us to start Reglan. Reglan
somewhat well tolerated. At 14 months baby finally begins to crawl, no
speech outside of babbling, social milestones otherwise normal. Then she
got a mild upper respiratory infection that turned into acute respiratory
distress and was admitted to children’s hospital for bronchiolitis. This
resolved quickly but since we were in the hospital, GI doc came by to check
up on us, was again not impressed by slow weight gain (6 oz. since the
Reglan started) and decided to go forth with the EGD (endoscopy).
Endoscopy: on visual exam, normal mucosa in esophagus, stomach and
duodenum.
Biopsy done: Positive for EOSINOPHILIC ESOPHAGITIS (caps just for
emphasis, not shouting)
EE is a chronic inflammatory disorder, in the allergy/immunology spectrum.
May be caused by environmental or food allergies or may be autoimmune
reaction. Previously considered a rare disorder, but now they are thinking
it is more common than we thought. Definitely not caused by
breastfeeding. Duh.
Thank you again for everyone who responded and wrote me regarding this
case. I thought every suggestion at a diagnosis or intervention was
excellent.
Anyone who guessed that the answer was in the allergy/immunology realm,
give yourself a nice pat on the back.
Warmly,
Anh H. Gordon, M. D., still bfing
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