Physician's Assistant

Refined clinic letter Thu 04 September 2025 11:21

Last Modified: 214 days ago

MRN:

Content:

Diagnosis:
Functional dyspepsia (suspected) - September 2025
Gastroesophageal reflux disease (suspected) - September 2025

Other Medical Diagnoses:
• Right vocal cord palsy - August 2025
• Previous thyroid surgery (hemithyroidectomy)
• Internal haemorrhoids
• Mild diverticulosis
• Simple fundic cyst (2021)
• Bereavement (recent loss of husband to cancer)

Current Medications:
• Gaviscon BD (after evening meal and at bedtime) - ONGOING
• Omeprazole 20mg PO PRN - TO BE STARTED (after H. pylori test)

Investigations:
• Blood tests (July 2025): Normal TSH, B12, folate, tTG, CA 125
• Gallbladder USS (April 2025): Thin walled, echo free, no sludge, stones or wall abnormalities
• Colonoscopy (December 2024): Sigmoid fixed and uncomfortable, very mild diverticulosis, internal haemorrhoids noted. Undertaken for rectal bleeding - no colonic cause identified
• Upper GI endoscopy (December 2021): Normal apart from likely simple fundic cyst, biopsies taken
• Private CT scan (March 2025): Normal (patient reports)

Management Plan:
1. H. pylori stool antigen test before starting omeprazole therapy
2. Trial omeprazole 20mg PRN for symptomatic relief when experiencing nausea/reflux symptoms
3. Dietary modifications - add chia seeds or flax seeds to morning porridge for improved bowel health
4. Patient-initiated follow-up available if symptoms deteriorate
5. Consider dietitian referral if no improvement with current management

I had the pleasure of meeting Mrs Stone in gastroenterology clinic today.

Her symptoms began in March/April with decreased appetite, feeling generally unwell with nausea, and over that time she lost over a stone in weight over the previous year. There was no disturbance to her bowels and reassuringly her weight loss has now stabilised.

Her symptoms resolved but then started again in approximately July with a retrosternal burning sensation. She saw the ENT team in August who diagnosed a right vocal cord palsy and wondered whether there may be an element of gastroesophageal reflux disease, suggesting Gaviscon. Her symptoms have improved with taking Gaviscon but she does have daily nausea and bloating.

We discussed her diet - she is nearly gluten-free but her previous coeliac serology was normal. She has porridge and fruit for breakfast, a sandwich for lunch and a small meal in the evening because she doesn't find that she's able to lie flat after a large meal.

In terms of her life more generally, she bravely opened up about the loss of her husband, and concerns about cancer are obviously playing on her mind.

I'm reassured that her GP plans a CT thorax in light of her previous thyroid operation and I'm sure that will visualise her oesophagus and stomach well to exclude anything concerning.

Regarding her bowels, she has urgency in the morning but without loose stools and usually tends more towards constipation. She passes between Type 4-5 stools although stool can intermittently become Type 1-2, opening once daily.

She had a recent private CT scan which she reports was entirely normal. We had a long discussion about the potential underlying causes for her symptoms. I'm reassured that her weight loss has stabilised and I don't think another invasive investigation is the right approach here. Given her symptoms have improved with Gaviscon, it's possible that gastroesophageal reflux disease or functional dyspepsia are driving her symptoms.

We've agreed today that we'll exclude Helicobacter pylori with a stool test and then trial omeprazole to manage any gastroesophageal reflux disease. I advised her to take this as and when she has symptoms rather than taking it regularly.

If the H. pylori test is negative and she doesn't have improvement with omeprazole, I suggest seeing a dietitian to discuss her diet as the next step. I'll enrol her into patient-initiated follow-up and she can contact us directly using the number at the top of this letter if she wishes to see us again should her symptoms deteriorate.

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Refined clinic letter Thu 04 September 2025 11:21

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