Digestive issues

Stomachache can warn of something more serious

Dr. William Muiños, a gastroenterologist at Miami Children's Hospital, shoots a video image of his hand with an endoscope. Mounted onto a long flexible shaft, the camera is useful for inspection of the digestive tract and other internal spaces.
Dr. William Muiños, a gastroenterologist at Miami Children's Hospital, shoots a video image of his hand with an endoscope. Mounted onto a long flexible shaft, the camera is useful for inspection of the digestive tract and other internal spaces.

Special to the Miami Herald

When Milad Zolnoor was a junior at Miami Killian Senior High School, he missed what his friends deemed “the best party of the year.”

Zolnoor, now 22, was an active teenager — until he got Crohn’s disease.

“I would go to parties. I liked being around friends, music. Friday night, I’d go out. Saturday night, I’d go out. Sunday, I would just do everything I needed to do because it is the last day before Monday,” said Zolnoor, of Kendall.

But once he got Crohn’s: “Friday night, I don’t feel like moving. Saturday night, I’d stay in bed. Sunday, I don’t even care,” he said. “That’s what it does to you. I would just stare blankly at the wall.”

Crohn’s is a type of inflammatory bowel disease where a disruption of the immune system causes certain proteins in the lining of the intestinal tract to be attacked, said Dr. William Muiños, pediatric gastroenterologist and associate director of the Division of Gastroenterology at Miami Children’s Hospital. Symptoms include significant weight loss, severe pain in the abdomen, diarrhea and fever.

“Socially, it’s very difficult especially being a teenager, and you have to go to the bathroom five times during math class,” Muiños said.

Crohn’s disease is one of many digestive conditions that are common in children and teenagers.

Dr. Mario Taño, pediatric gastroenterologist at Joe DiMaggio Children’s Hospital in Hollywood, separates children’s digestive problems into two groups: Functional, which are caused by poor diets, lack of activity, irregular bathroom visits or outside stimuli such as stress; and disease-related, which are caused by a disease.

The stress factor

When it comes to functional digestive conditions in children, back-to-school stress is as much of a culprit as diet or inactivity.

“We do see an upswing of pediatric abdominal pain with the weeks after starting school,” Muiños said. “These are real phenomena that are related to external stimuli in the world. When kids go to school, especially the little ones, they get some separation anxiety. They are going to meet a new teacher, and they are nervous about that.”

Irritable bowel syndrome (not to be confused with inflammatory bowel disease, which is a general term for a disease-related condition) is a functional digestive disorder that may target the upper or lower bowel. While non-peptic dyspepsia occurs in the upper bowel and results in the production of more acid, spastic colitis is in the lower bowel and results in cramps and diarrhea without any evidence of inflammation in the digestive tract, Muiños said.

A change in the child’s diet can help treat both — high-in-protein foods like egg whites and fruits are better than sugary cereals and chocolate milk.

Ignoring the urge

Constipation is often seen in younger children, who tend to avoid going to the bathroom even if they get the urge, Taño said.

“Eventually, since you are eating every day and not pooping every day, it ends up hurting when you have to go,” he said. “It turns into chronic constipation.”

Taño recommends his young patients try to go to the bathroom at least every other day.

When a young patient with cramps or irregular bowel movement first walks into Taño’s office at Joe DiMaggio, the doctor asks a series of medical-history questions.

“I would first try to be like Sherlock Holmes as far as the history,” he said. “How long have you had the pain? Where? Is it always there or does it come and go? What brings it on? Before you know it, I haven’t put my hands on the child, and I already have a clue whether this is more serious or less serious.”

If it is more serious, it would likely fall under the disease-related category.

Dr. Jennifer Garcia, pediatric gastroenterologist at Holtz Children’s Hospital at University of Miami/Jackson Memorial Medical Center, groups digestive disorders based on the child’s age:

Reflux and allergies are most common in infants. In reflux, a valve that divides the esophagus and stomach does not close properly, food comes back up and the baby throws up, Garcia said. Babies may also develop allergies, usually from their formula.

“They’ll present in the same way — cranky baby who does not want to eat,” she said.

Gastritis and H. pylori infection are most common in 4 to 11 year olds. In gastritis, the stomach or the intestines are inflamed because of a virus.

“Instead of the virus giving you cough and cold, it makes you throw up,” Garcia said.

H. pylori infection is a bacteria transmitted from child to child, especially in junior high.

Inflammatory bowel disease is most common in teenagers. It’s a general category for Crohn’s disease as well as for ulcerative colitis. In ulcerative colitis, the immune system attacks the colon, which causes cramps, diarrhea, weight loss and possible fever, Muiños said.

Both diseases are more likely to occur if a patient has family history of them. And both may go into remission and then reappear.

Such was the case with Zolnoor, who was fine for about two years after his initial diagnosis. He took steroids, immune-system suppressants and medicines that reduced inflammation in the digestive tract.

Then one day, as he headed to his English class at Miami Dade College, he felt a “massive explosion” in the lower right quadrant of his abdominal cavity.

Turns out an infection, formed as a result of the Crohn’s disease, had perforated in Zolnoor’s abdomen creating an abscess, Muiños said. That called for a surgery to drain the “thick lime-green fluid” that had accumulated in the abscess.

Disease-related problems could also result from the inability to digest certain foods, such as wheat or milk.

While those with celiac disease are unable to digest gluten and wheat products, those diagnosed with lactose intolerance do not produce an enzyme that helps digest lactose, a natural sugar in dairy.

And then there are the rare cases where babies are born without part of their intestine, such as Short Bowel Syndrome, where part of the small bowel is missing. That decreases the ability of the intestines to absorb nutrition.

The University of Miami Miller School of Medicine Intestinal Rehabilitation Program provides such patients with an alternative to transplantations.

Through IV-received nutrition, doctors and nutritionists nurse the patient’s existing and functioning bowel to help it adapt and absorb nutrition.

“You are working along the way depending on their anatomy and depending on what part of their intestine is missing,” Garcia said. “When you are rehabilitating them, their intestine is very smart and tries to rehabilitate itself.”

For Zolnoor, whose Crohn’s disease has gone into remission, life now closely resembles what it used to be like before he got the disease. In January he will start classes at Florida International University, where he plans to major in chemistry. Soon, he will also take the MCATs. He often play basketball with his friends and can eat whatever he wants, although he strives to keep a healthy diet.

“I think the disease was something that was bound to happen to me,” he said.

“If I had to do it all over again, I would. Guys, when they are 17, they kind of have a big ego. But Crohn’s, it sort of brings you back to earth.”

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