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Rapidreview (150 days ago 16:23)

Rapidreview Fri 07 November 2025 16:23

Last Modified: 150 days ago

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GASTROENTEROLOGY CONSULTATION

Date: 07/11/2025
Patient: MCGUGAN, Rosanne Elizabeth D (Mrs)

HISTORY:
79-year-old lady presenting with increased bowel frequency and loose, watery stools for several months. Patient reports symptoms began after colesevelam was changed from generic to branded version. Patient describes rushing to toilet with watery stools multiple times daily, associated with abdominal discomfort and bloating. No rectal bleeding reported. Patient stopped the branded colesevelam due to worsening symptoms and has recently been switched back to tablet form.

PAST MEDICAL HISTORY:
- Crohn's disease (previous right hemicolectomy)
- Age-related macular degeneration
- COPD
- Rheumatoid arthritis
- Osteoarthritis
- Leg ulcers

SOCIAL HISTORY:
Smokes once daily, lives alone with three times daily care package.

EXAMINATION:
Elderly, thin lady sitting comfortably in chair.

INVESTIGATIONS:
- CT scan: Shows colonic inflammation in patches, no sinister findings
- Inflammatory markers: Raised
- Faecal calprotectin: Elevated

ASSESSMENT:
Symptoms clearly temporally related to medication change, consistent with bile acid malabsorption. However, CT findings of colonic inflammation and raised faecal calprotectin require further investigation to exclude Crohn's disease recurrence or other pathology.

PLAN:
1. Restart colesevelam tablets (patient preference over sachets)
2. If bowel habit normalises - discharge home with outpatient colonoscopy
3. If symptoms persist - inpatient flexible sigmoidoscopy
4. Review CT images with GI radiology to clarify extent of colitis
5. Investigation pathway depends on imaging review:
   - Widespread colitis: outpatient colonoscopy
   - Localised sigmoid changes: outpatient flexible sigmoidoscopy
   - Persistent symptoms: inpatient flexible sigmoidoscopy

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Rapidreview Fri 07 November 2025 16:23

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