Persistent Vomiting in an Adolescent – Not a Crying Matter

Letter to the editor

Austin J Gastroenterol. 2014;1(2): 1008.

Persistent Vomiting in an Adolescent – Not a Crying Matter

Aaron Johnston1 and Michael J Nowicki2*

1Department of Pediatrics, University of Mississippi Health Center, USA

2Department of Pediatric Gastroenterology, University of Mississippi Health Center, USA

*Corresponding author: :Michael J Nowicki, Department of Pediatric Gastroenterology, University of Mississippi Health Center, 2500, North State Street, Jackson, MS, 39216, USA

Received: June 12, 2014; Accepted: June 25, 2014; Published: June 27, 2014

We report an adolescent with Triple-A syndrome (Addison�s disease, achalasia, and alacrima) to remind your readers of this rare condition. A 13-year-old male presented with a six month history of non-bilious, non-bloody post-prandial vomiting. He denied associated abdominal pain, headaches, and nocturnal vomiting. Past history was significant for Addison�s disease, prior hypoglycemic seizures, and scoliosis; his only surgery was repair of a tethered cord. Examination revealed a well-nourished male with marked scoliosis. Heart and lung examinations were normal. His abdomen was soft, non-tender, and without hepatosplenomegaly. Laboratory evaluation included normal values for complete blood count, erythrocyte sedimentation rate, liver panel, lipase, serum electrolytes, and glucose. A presumptive diagnosis of gastro esophageal reflux was made and he was started on a daily proton pump inhibitor.

At 6 month follow-up he had gained 1.9 kg despite persistence of vomiting. His examination remained unrevealing. An upper gastrointestinal series was obtained, showing findings suggestive for a stricture at the gastro esophageal junction causing almost complete obstruction (Figure 1). He was scheduled for esophagogastroduod endoscopy with balloon dilation for presumed peptic stricture the following day.

Citation: Johnston A and Nowicki MJ. Persistent Vomiting in an Adolescent – Not a Crying Matter. Austin J Gastroenterol. 2014;1(2): 1008. ISSN:2381-9219