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My son who has CdLS is 11 years old. He had GI surgery over a year ago. Why would his stool be green and hard? He also has lots of cramping in his lower stomach. He is also experiencing burning sensations in his throat again and having frequent ear infections.

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The usual cause of green, hard stool would be constipation. Cramping could accompany this. I usually recommend dietary intervention for constipation, such as increasing fiber, water/fluid intake and decreasing foods that cause constipation (e.g. BRAT diet - bananas, rice, applesauce, toast). Because this patient has had abdominal surgery, the abdominal pain could possibly be related to that - e.g. adhesions from surgery can cause acute abdominal pain, although constipation should not occur with this (this would be very rare). The pain in the throat sounds like reflux - could the original Nissen have become loosened? Probably the original gastroenterologist and/or pediatric surgeon should reevaluate him to rule out these things, and then constipation could be addressed if nothing else appears related. Recurrent ear infections are common, and can be medically treated with prophylactic antibiotics or by placement of tubes in the ears by an Ear Nose and Throat specialist.

TK (4-10-01)

Answer is checked and valid for


Constipation of the bowels (Obstipation)

Constipation is present in almost half of all individuals with CdLS and should be treated as in the general population.



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.

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