Mucus in the stool

Question

Dear ladies and gentlemen,
our son is now 13 weeks old.
Since the second week that I stopped breast feeding, he has mucus in the stool.
We have been in the hospital and have been discharged with the suspicion for cow's milk allergy and with a special milk.
Abdominal pain, flatulence, diarrhoe and blood in the stool have disappeared since the beginning with Neocate® (highly hydrolized milk on amico acid basis), however the mucus in the stool, the reason we went to the pediatrician, stayed.
He gains weight well. Birth weight 2700g, now with 13 weeks 5900g.
Our midwife recommended to have him tested for CF. In the hospital and also at the pediatrician they do not want to hear anything about it. In the hospital they have told us, that they had nevertheless made a test for CF and measured the value for pancreatic elastase. This value was o.k.
I know that this value is not a test for CF.
Is the pancreatic elastase always decreased in children with CF or can it indeed be that this value is normal?
He has no problems with his lung, has at the moment however a cold, has had however at any time a free lung.
Can one say that in case of the symptom of mucus in the stool alone, one should initiate further tests for CF?
I am very thankful for an answer!!
Best regards
A.G.

Answer

Hello,
you report, that mucus in the stool has been observed at your now 13 week-old child after stopping breast feeding (seemingly there had been also blood in the stool, abdominal pain and flatulences) and that because of the suspicion of a cow's milk allergy, a change of the feeding to Neocate® was done. Since then, the abdominal pain and the flatulences as well as the blood in the stool disappeared, while the mucus in the stool stayed. Your child has gained weight well under the treatment. A measurement of the pancreatic elastase had been done, that had showed a normal result. You report furthermore, that your child has no lung problems until now. You ask, if with this the illness of CF can be excluded.
About 20% of young CF patients have a normal pancreatic function. Therefore the illness of CF cannot be excluded with the existing laboratory results. Mucus in the stool however, as a sole sign of CF, is absolutely unusual.
Therefore I am of the opinion, that at the moment, you do not have to initiate further investigations for CF, unless you could not calm down without a secure exclusion of the disease. A sweat test could in this case be initiated from your pediatrician. With high probability the observed mucus in the stool is a sign that the mucosa of your child is still in the healing phase.

Yours sincerely,
Dr. H.-G. Posselt

17.02.2015