Endoscopy Notes Anke Tillman
Ask the doctor to retroflex and look up at the stomach Fundus and LES. This is how he could see a hernia if there would be one.
An EGD coming back normal may be frustrating, after going through such an invasive procedure in search of answers. The answers can be in the non-findings, respectively the things that have been ruled out now. Your little one has no histological changes in the mucosa, no esophagitis, which tells the acid management has been sufficient enough recently to avoid this happening. He has no EoE, which is a blessing as well. They very likely have ruled out celiac disease, as well as ulcers. Overall, this is reassuring in a way that nothing seems to be in the way to outgrow this. However, this does not mean there is no reflux, this procedure is not to proof if there is reflux or not, it is to assess the mucosa. I still wonder if he retroflexed the scope and looked upwards, because it would be interesting to know how the LES looked, and if there would have been a hiatal hernia he would have very likely seen it.
A clear scope only tells no major harm from recent acid reflux, most likely no hernia (and that is only if they did it right, with the retroflexing) and no histological chances, no malabsorption of carbohydrates and most likely no celiac, sometimes they also check for heliobacter too. But that’s it, if these all are ok, it only means to look even further.
The scope can neither rule out reflux nor allergies. Please do not add new foods now, if your little one is still having reflux symptoms. The only thing your GI can tell allergy-wise from the scope, is that your little one does not have EoE. That would be eosinophilic cells in his esophagus and obviously in the path report they were not there, so this is great, but doesn’t mean one can have no allergies.
For this evaluation you need to see an allergist, as they know specifically about allergies and intolerances. Obviously he did not detect an hernia (I would still ask him if he had looked for one by retroflexing the scope in the stomach) and, all other biopsies from the small intestines were norma,l so you don’t have malabsorptions or celiac. Not 100 % reliable at that age [5 months], but reassuring for now.
By the scope, he has a absolutely no possibility to say if there is reflux or not. The only thing that that he would have been able to diagnose would have been erosions, furrowing or an inflamed skin in the esophagus. But, if your son was on PPI for most of the time, this damage does not happen too soon, it is mostly more prominent in totally unmedicated reflux cases. His conclusion as of latent constipation for now is at least a try worth, but then would raise the question where does it come from, and then the cycle is closing again to food intolerances, or even allergies because they are causing Latent Constipation a lot. You can treat that empirically with laxatives, but mostly moms want answers: what is the root cause, to have more of long term solution, etc. So again, an allergist consultation (with some bloodwork) would be in order.