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Some time ago there was a very concerned letter from a young woman whose little daughter was having bloody diarrhea and her doctor wanted to do a colonoscopy.  She questioned whether or not the procedure would be safe for her child.    I printed the message, but as our MD friend was out of the country at the time, having just retired, I could not send it to him then.  Finally sent it last week, and here is his response.  For obvioius reasons, he asked that his name and e-mail address not be sent on to the list.  If you want to send follow up questions or comments, I would be happy to forward them to him and will send his responses to the LIST.

To: gayle and george kennedy 
Sent: Saturday, October 07, 2006 7:41 AM


Hi Gayle and George, 
I got your note about colonoscopy preps and will send my thoughts on it to you, and you can send it on to the celiac society if you wish. 

Basically I used to put patients on clear liguids the day before and then the night before the procedure, if they were relatively young, and healthy, I would use Fleet's phosphosoda and lots of fluids like gator aide. Fleet's phospho soda is contraindicated in older, frailer patients, esp those with diabetes or hypertension or congestive heart failure and on anyone taking diuretics or ACE inhibitors. Concerns about kidney failure are real with the Fleet's phosphosoda but patients tolerate it better then the gallon jug of Colyte.

 In general I avoided scoping a young person with sudden bloody diarrhea since usually that is an infection like Camylobacter, E-coli, or shigella and I'd get stool cultures and treat with cipro if I was pretty sure it wasn't E-coli 057  which is best left untreated. If I did scope someone with boody diarrea I just put them on clear liguids the day before and used no prep. 

Someone mentioned capsular endoscopy as an alternative. That visulizes the small intestine and not the colon.

Someone else mentioned just a sigmoid and that is what we used  to do, but it misses about half of the early malignancies that we can cure.

Regarding colonscopy in someone with non- tropical sprue, that shouldn't be factor since they prep like anyone else.

Lastly I can't resist a response to the person that suggesed that doctors have no idea about how much suffering goes with the prep. We're not all babes in the woods. Three of the four gastroenterologists in my group have had a least one
colonoscopy.  I've had two, had both preps and disliked them both.

End of the doctor's message.

I hope this will be of help to someone.  I imagine he would like to know how the little girl in the first message is doing, and what the result was if she had the test.  
Good health to all of you.  Gayle Kennedy
 


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