Is it VEOIBD?

[lauradee]

Hello, my 4 yo son has had iron deficiency anemia since the pediatrician began testing his iron levels (~18 mo) and has been on oral supplements for years with no improvement. He is having episodic gastrointestinal bleeding (2-5 bowel movements in a row every ~6 weeks). The blood fully saturates/is evenly incorporated with his stool. Calprotectin in the 700s. He has had an upper and lower endoscopy, Meckel's scan, capsule endoscopy, all inconclusive although capsule showed "slight redness." He has been on oral budenoside for ~6 weeks with no improvement (iron supplements ongoing). Some other possibly relevant info: he has two external hemangiomas and his dad has HLA-B27. I suppose my question is, could it be anything other than VEOIBD? Why so much blood without anything showing up on tests? What is next? Should he have IV iron? What other tests? Thanks for any thoughts!

 

[Administrator]

Thanks for joining, this is actually a very challenging clinical case. Some thoughts I hope may be helpful.

- I would still consider Meckels as a diagnosis. Sometimes it is hard to diagnose and scan can be negative.
- calpro is trendable. Dont just do one, you can do one every 4 weeks or every 8 weeks or any combination that makes sense. 700 is high but where did it go after a weeks time?
- What is budesonide treating? why not try something more general like PO steroids or even infliximab. Not saying he has IBD but one strategy can be treat possible IBD and trend calpro.

whatever happens, please keep us posted!