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GI Issues related to Mouth Odor/Teeth Darkening


The mother of a 12-year old girl has reported symptoms that she feels may be indicative of larger problems and need further evaluation. Her doctor does not agree. The child had been healthy until recently. She began to omit a rotten odor from her mouth/head, her teeth began to darken, and she seemed to be congested with mucus. The child was hospitalized for one week and released after symptoms of congestion and odor seemed to subside. Dental concerns were ruled out and Mom tried to pursue an endoscopy. The Gastroenterologist stated that since the child has had a Nissen and was on Prilosec that she was not able to reflux, therefore an endoscopy would not be necessary. The diagnosis provided during the recent hospital stay was a severe virus causing gastroenteritis. Mom reports that the child is still exhibiting arching

Mom is seeking an endoscopy (or full upper GI) and possibly an ENT evaluation to rule out sinusitis

Is her request for an endoscopy or other further follow up warranted? Is it possible to reflux silently even after a Nissen and while on Prilosec?

Answer of our experts

You can reflux after a Nissen. You can have esophagitis even on Prilosec. Sinusitis can cause these symptoms also. A follow up GI study is warranted, as well as an ENT evaluation

CP/TK 7-13-10

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Consider always gastro-oesophageal reflux disease (GORD) in any individual with CdLS owing to its frequency and wide variability in presentation, which includes challenging behaviour.
Modification of nutrition and proton pump inhibitors (PPI) are the first-line treatments of GORD. Anti-reflux medications need to be used to their maximum dosage. Surgical interventions for GORD should be limited to those individuals with CdLS in whom nutritional and medical treatments have been unsuccessful or airway safety is at risk.
If GORD symptoms persist, endoscopy should be strongly considered whilst an individual with CdLS is still in paediatric care.
Surveillance for Barrett’s Oesophagus needs to be discussed with and decided together with the family, balancing the potential gain in health and burden for the individual with CdLS.


Mouth, nose and throat

The anaesthesiologist should be aware of the potential difficulty with intubation in individuals with CdLS.

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