My 4 yr old has really smelly fatty sticky poo but otherwise healthy, anyone know why?

[Ellisx]

My 4 year old son has had bowel problems for the past 18 months. He is full of wind, regularly soils his pants when he passes wind and his poo has not looked normal for this time as it is really smelly and greasy (very hard to flush as it sticks to the pan). We have seen a specialist, had blood tests and poo tests but they can’t see any reason for his problems. He has tested negative for Chrohns and Celiac and no blood in his poop. The only thing I could think of is that he had a dose of long term antibiotics when he first started getting the symptoms 18 months ago for his glue ear. I tried probiotics which have made no difference, also tried movocol at first because the GP thought it was impaction from the symptoms. I am at my whits end as he comes home from school everyday with soiled pants. His tests did show a slightly higher intolerance to egg white but excluding that made no difference either.
Has anyone else had this problem? The Specialist has suggested another course of antibiotics to reset the bacteria or a low dose of loperamide to stop him from soiling. Neither of those options sound good to me.

DS does have coeliac disease and this is exactly what his poo was like. 2 weeks into gluten free diet and his mood improved to the extent that it was like having a different child. It took longer for his guts to return to normal, but coeliac is auto-immune, rather than an intolerance.

It sounds very like coeliac from your initial description, and a good response to a gluten-free diet makes it highly likely. Ideally he should have an endoscopy to confirm, and when you do see a specialist they will probably want him back on a gluten-containing diet for about 6 weeks (off the top of my head) prior to doing this. I agree that testing to exclude CF as a cause of malabsorption is probably indicated, hopefully this has already been done.

Someone suggested a genetic test could help - yes this can be helpful but only exclude coeliac as a possibility, not diagnose it positively. (runs in my family and one of my children has had genetics checked which merely confirmed he could be susceptible, but his current symptoms don't warrant endoscopy)

My daughters have a fructose intolerance and a lot of their symptoms are as you describe. When you said he’d had an explosive poo after eating fruit, it rang alarm bells! Dried fruit in particular can cause a bad reaction, along with apples and pears.

My eldest was diagnosed by having a hydrogen breath test (she’s also lactose intolerant and used to have pale poos).

He had a heal prick test at birth for CF so it’s not that. Things have definitely improved since going GF and I think yesterday was a blip with fruit overload. I agree it is most probably more than one intolerance or allergy but it’s not much fun finding out! His mood is showing an improvement too although he is always complaining of feeling tired and that could just be an age related thing. Doctors just don’t seem bothered as he is still gaining weight and growing at a normal rate. Today was a good day. Normal poo, no stains in pants and a generally happy boy.

@pattylogic I have a mild intolerance to dried fruit, perhaps he’s got that from me along with my eczema 😏

Yes, I think all boroughs now include CF in the heel prick test, I just didn't know there were other reasons you might not be able to digest fat. I hope you find out what he's intolerant of soon.