DD15 frequent diarrhoea - what wld you do?

[Chocguzel]

DD is 15 and has always had a sensitive stomach: often in pain, always on the loo, vomits after ibuprofen, first to get every stomach virus since birth. She is stoic about it.

If she eats spicy food, even mild spice like chicken tikka masala, she will be running to the loo within 15 mins of eating and it will all come straight out in its entirety as diarrhoea. She will be on the loo for about an hour after the meal. Is she eats deep fried food, or too creamy food, the same happens although slightly less violently.

her BMI is 18.5 despite eating loads. She has mouth ulcers frequently. Her periods have never been regular.

Coeliacs runs in the family but she’s been tested and is all clear. Wheat actually is one thing that doesn’t obviously bother her. Blood tests all normal except iron is a little low.

is this just IBS or could it be something more?

I would keep pushing for more tests to check for inflammation, especially as she is getting mouth ulcers and you feel her weight doesn’t correlate with the amount she eats.

These things can be associated with ‘regular’ IBS but can also be a sign of more serious IBDs like Crohns and Ulcerative Colitis.

Your poor DD. Can I ask, what screening did she have for coeliac? My child is coeliac and it was diagnosed by blood test but her cousin who is in Ireland was diagnosed by endoscopy. His blood test results were normal but endoscopy revealed he had coeliac disease. He had very similar symptoms to your DD. I hope you can get some answers. Wish you all the best

Poor her. Maybe get her checked for bile malabsorption. Apparently this is unusual so doctors don’t check for it but if she is found to be suffering from it then it can be treated and she will have her life back to normal.
Constant diarrhoea makes life so difficult.

Push for a calprotectin test [ stool sample that looks for inflammation]. It could be crohns or colitis. Stop giving ibuprofen as this can really upset the stomach if she has underlining issues.
If they suspect crohns or colitis or coeliac she will need to have a colonoscopy and endoscopy to determine which it is.
Try to get her seen ASAP.

I couldn't help but notice that all the foods you mentioned she eats are spicy, fried, fatty and greasy. If this is her diet, no wonder she has stomach issues. Where are the fresh meats? Fish? Vegetables? Fruits? Yogurt? Do you not cook and eat food in your family that is not spicy or fried? Salads? Roasted chickens? Rice?

No, she said 'when' she eats those types of foods she reacts, not that she only eats them.

Where did you get that, that’s all she eats?

The mouth ulcers could be crohns?

Could it be an intolerance / allergy to milk? My little boy is only 1 but had awful upset stomachs until I cut milk out of his diet. He now has normal movements and is a lot more settled at night.

He was fine on formula, but had a terrible stomach when he moved to solids. Removing anything with milk in his diet had significantly improved this for him.

Could be. Chrons as mentioned and also Cealiac disease. Could also be IBS. Is it when she eats onions for example?

Does she use a toothpaste with Sodium lauryl sulfate (SLS)? I get terrible mouth ulcers when I brush only once with this.

Either way I would return to gp and request further testing.

There are a lot of other possible intolerances.

I was the same as a teen and for me it was lactose intolerance.

it can take a while for your bowel to settle down after you cut out something.

she should try cutting out some of the most common intolerances:
caffeine, dairy, citrus.

one at a time, not all at once.

six weeks is usually long enough to tell.

I would look at milk too.

dd was the same, frequent bouts of d&v we put down to stomach bugs, ibs type symptoms, really smelly BM.

when she was about 14 she was hit with really severe acne. After trying all the usual she decided to try a 2 week trial of no dairy after seeing something on TikTok.

well the difference. No more “stomach bugs” which in hindsight were after a particularly dairy heavy meal. The acne cleared, she says she doesn’t have that low level nausea all the time.

looking back I can see the links. I just didn’t put it together. She’s now also cut out gluten as apparently it’s often linked, and feels even better. She won’t do a gluten trial for a coeliac test as it makes her feel so much worse, so don’t know whether she is coeliac or not, but it’s working for her.

So the solution is to simply not eat that kind of food, if she's otherwise okay with her stomach when she eats other things.

Nightshade intolerance? Tomatoes and peppers in particular (including spices) can wreak digestive havoc and are usually in spicy foods, so you think the culprit is the spiciness but actually it’s the tomato. May be worth cutting those out completely for a couple of weeks to see if it makes any difference - you will be able to tell really quickly.

Thanks for all your really helpful posts.

to answer a few questions:

The coealic test she had was a blood test for antibodies after eating lots of gluten for a few weeks. It was negative. The GP said the NHS would not test further on the back of that.

She has a varied diet and of course she doesn’t just eat fatty and spicy foods. She loves salads but if I put a chilli in the salad, which she loves, even that can set her off. Also she’s a teen, she’s crap at not eating a load of chips or something if her friends and her go out.

she seems ok with dairy incl ice cream but things like cheesecake that are really creamy and fatty

her only other odd physical things is loads of pale birth marks appearing and growing bigger and bigger on her back and arms. V odd.

I will follow some of the advice here to cut out things in turn and not reactions. I will also push for more tests but the GP was quite at a loss of what was appropriate after the blood tests seemed OK.

thanks again all.

Pale birth marks - is it possible they are patches of vitiligo? I asm because it's an autoimmune condition.

I second this as my daughter had similar symptoms and always had mouth ulcers. Turned out to be Crohn’s disease.

Irritable bowel causes sudden post-food squits. In one end triggers exaggerated gut activity and out the other end it goes.
Crohns needs investigating as the two can be confused.
Sensitivity to dairy can be weird ... e.g. I cannot drink milk but can have yoghurt ... this is not unusual.

Is she in good health otherwise or is she fatigued? Wondering about early stage Addisons disease - that usually causes hyperpigmentation, but in some cases it can cause patches of paler skin instead. Ask for a 9am cortisol blood test if she has any symptoms other than just the bowel stuff.

https://crohnsandcolitis.org.uk/

please look at C&CUK, it’s a charity and they have a brilliant symptom checker and a letter for you to print out and take to the GP explaining her symptoms so she can be referred to a specialist with little delay.

the website has brilliant resources and information.
Good luck x

Please please don’t faff about cutting foods out and procrastinating about what it could be, just get her to the GP, get the tests and get the diagnosis because the sooner you do, the sooner her quality of life can improve and prevention of things deteriorating.
If it is an IBD (NOT IBS) there are specific treatments that can be given that are game changers.

GP here, OP; with this set of symptoms I would be keen to rule out Crohn's Disease. Typically blood markers of inflammation will be raised, but this isn't a guarantee, and while the frequent diarrhoea alone could suggest IBS, the mouth ulcers and failure to gain weight are red flags for a more significant condition. Faecal calprotectin would be a good start, but even that isn't definitive, and I would be referring to a Gastroenterologist in this scenario.

Ibuprofen is recognised as being very harsh on the stomach. Some in my family can not tolerate it at all. When you are at your GP fololwing up on more tests etc, ask for alternatives to Ibuprofen.

I agree with others that she needs to be investigated for Inflammatory Bowel Disease, the mouth ulcers with other symptoms could be indicative of Crohns Disease (not a hard & fast rule).

Unlike IBS, IBD is an autoimmune disease and much more serious. It is treatable, however, and there are a wide range of treatments available now.

Push for endoscopy as well as bloods, and a gastro referral.

A refreshing change to actually read a review of a GP who seems to have knowledge on IBD. Unfortunately not many GP’s don’t so some poor children are left without treatment whilst their gut is becoming more damaged.
This was the case for my 12 year old daughter, oyr GP completely dismissed the mouth ulcers, paleness and tiredness for over a year of me taking her back to see him.
Had enough of waiting for him to do anything and asked our dentist for advice on the mouth ulcers.
Thank god I did because it was through that that my daughter was eventually diagnosed with Crohn’s disease. Unfortunately for my daughter by this time her gut was badly damaged.
Thankfully medication today has come on wonders and repaired her gut and at age 19 now she is living a fantastic active life.
So please be the voice for your child and keep pestering until you have answers.

I have emailed the Gp but he says no appointment as he already checked for inflammatory markers in the blood and there were none.

I would not have been surprised if was autoimmune. Her grandpa and cousins have has coeliacs and she has always had raynauds. But the inflammatory markers were normal.

After reading a post above I now wondering about Addisons disease. The birth marks are like the colour of milky coffee on her very pale skin. They cover a lot of her back now and look like some of the pics of addisons hyperpigmentation I can see online. She also has the issues with her periods, the weight loss and upset stomach. Also I see craving salty foods is a thing and she loves salt. Probably being paranoid though. Also not sure what to do as GP won’t give an appt as says blood tests were all normal.