Thank you for your consult at DoctorSpring.com.
I understand your concerns. Your child as well as the two of you seemed to have suffered significantly from this distressing problem of chronic vomiting. You have got your child extensively evaluated as well (I have seen the attached reports). In situations such as these, no amount of theoretical advice can replace a through history and examination of the child. Does your son grow normally? What is his height and weight at 4.5 year? Growth failure can be an important clue in the diagnosis of many conditions. He does not appear to be significantly anaemic (Hb of 12)
Some of the investigations that may be useful in your child include:
1. Absolute eosinophil counts, Serum IgE levels, Food allergy tests - skin prick and patch tests
(If there is a strong clinical suspicion of allergic enteritis, 'Six food elimination diet' can be tried after medical advice from a pediatric gastro-enterologist. This involves avoiding milk, soy, wheat, egg, peanuts and other nuts. Many people have symptomatic benefit from this regimen)
2. Stool examination for malabsorption as well as parasites and cysts can be useful for ruling out related conditions of the gastrointestinal tract. Your child has chronic enteritis on all his intestinal biopsy specimens. This suggests chronic inflammation in the gut. The cause of this chronic inflammation could be infections, auto-immune as well as idiopathic conditions. Hence, it is important to get these stool tests.
3. MR enterography and capsule video endoscopy can be considered as options to evaluate the whole gastrointestinal tract. It could be useful in the diagnosis of CROHN's disease and inflammatory bowel diseases.
4. Is your child neurologically normal for a four year old. Does he have any developmental delay? Does he have any history of seizures or neck pain or migraine. Though unlikely in your child, chronic vomiting due to extra-abdominal causes, including central nervous system lesions like ARNOLD-CHIARI malformation or hydrocephalus and functional causes are also known.
Regarding the treatment of such conditions, proton pump inhibitors (esomeprazole - Nexium) and similar compounds can help in a wide variety of disorders and hence are widely prescribed. Till, a more definitive diagnosis can be made, it would not be wrong to continue Omar on these drugs for symptomatic therapy.
I hope that my clarifications were of some use. In case you have any follow-up queries, please feel free to revert back.
Wishing OMAR a speedy recovery.
Dr. Saptharishi L G