Physician's Assistant

Patient Details

Refined clinic letter (94 days ago 10:28)

Refined clinic letter Fri 02 January 2026 10:28

Last Modified: 94 days ago

MRN:

Content:

Diagnosis:
Coeliac Disease - diagnosed 2018

Other Medical Diagnoses:
• GORD with oesophagitis - 2004
• Mild COPD
• Vitamin D deficiency
• Iron deficiency anaemia - 2024
• Previous TB peritonitis as child (required 2 years sanatorium treatment)
• Multiple food intolerances (dairy, soy, vegetables, fruits)

Current Medications:
• Ventolin inhaler PRN
• Stexerol D3 (vitamin D supplement)
• Omeprazole 10-20mg PO OD
• Trimbow inhaler
• Ferric maltol 30mg PO OD - STARTED TODAY

Investigations:
• TTG (November 2025): 5.2 - normal, indicating good coeliac disease control
• FIT test (October 2025): 05/2009 - negative for blood
• FBC (November 2025): Hb 117g/L (previous 115g/L), normal MCV
• Transferrin saturation (October 2025): 8% (low), Transferrin 3.1 (low)
• Folate (November 2025): 5.3 - normal
• B12 (November 2025): 353 - normal
• Ferritin (October 2025): 29 - low
• Historical review shows gradually declining Hb since 2021, briefly anaemic in 2024

Management Plan:
1. Trial ferric maltol 30mg once daily, may increase to 30mg twice daily if tolerated
2. If ferric maltol not tolerated, arrange iron infusion
3. Patient declined invasive investigations (endoscopy, CT with prep) but happy to pursue if symptoms change
4. Patient to contact department if iron supplementation ineffective or not tolerated
5. No routine follow-up appointment arranged - patient-initiated contact as needed

I had the pleasure of meeting Mrs Hughes in gastroenterology clinic today on behalf of Dr Poles. The consultation was face-to-face.

Mrs Hughes is now 84 years old and has been strictly gluten-free with her coeliac disease. She is also intolerant to milk, dairy, vegetables, fruit and red meat. She describes not enjoying eating and feeling nauseated after eating, which has been a lifelong issue. Her diet is extremely restricted - typically free-from cereal for breakfast, gluten-free bread with marmalade for lunch, and rice with chicken for dinner. Since her iron deficiency anaemia diagnosis, she has increased from two to three meals daily and has gained a couple of pounds in weight.

She has no gastrointestinal symptoms of note and her bowels are normal for her. We discussed that iron deficiency anaemia carries approximately 10% risk of underlying malignancy, however her reassuringly normal FIT test and clear dietary explanation for iron deficiency reduces this risk. She declined invasive investigations including endoscopy and CT scanning with bowel preparation, understanding the small residual risk but feeling confident this represents dietary deficiency given her severely restricted diet devoid of vitamin C and iron-rich foods.

Regarding iron replacement, she has been completely intolerant of standard iron preparations in the past. I have prescribed ferric maltol 30mg daily, which is usually well tolerated in patients with inflammatory bowel diseases. She can increase this stepwise to 60mg twice daily if well tolerated. If this proves ineffective or poorly tolerated, I will arrange iron infusions. She is welcome to contact the department at any time if needed, but no routine follow-up has been arranged.

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Refined clinic letter (94 days ago 10:31)

Refined clinic letter Fri 02 January 2026 10:31

Last Modified: 94 days ago

MRN:

Content:

Diagnosis:
Iron deficiency anaemia

Other Medical Diagnoses:
• Coeliac disease
• GORD with oesophagitis - 2004
• Mild COPD
• Vitamin D deficiency
• Multiple food intolerances (dairy, soy, vegetables, fruits)
• TB peritonitis in childhood - 2 years in sanatorium

Current Medications:
• Ventolin inhaler PRN
• Stexerol D3 (vitamin D supplement)
• Omeprazole 10-20mg PO OD
• Trimbow inhaler
• Feraccru 30mg PO OD - STARTED TODAY

Investigations:
• TTG November 2025: 5.2
• FBC November 2025: Hb 117 (previously 115), normal MCV
• Iron studies October 2025: Transferrin saturation 8%, transferrin 3.1, ferritin 29
• Folate November 2025: 5.3
• B12 November 2025: 353
• qFIT test 2025: <5

Management Plan:
1. Trial of ferric maltol 30mg OD, may increase to 30mg BD if tolerated
2. Patient offered CT abdomen and pelvis with gastrograffin prep and upper GI endoscopy if wishes to pursue investigations
3. Iron infusion if ferric maltol not tolerated
4. Patient to contact clinic if not tolerating medication or wishes to pursue investigations

I had the pleasure of meeting Mrs Hughes in gastroenterology clinic today on behalf of Dr Powles. The consultation was face to face.

Mrs Hughes is now 84 and strictly gluten-free with her coeliac disease. She is also intolerant to milk, dairy, vegetables, fruit and red meat. She reports that she doesn't really like eating and feels nauseated after eating, which has been ongoing for many years.

Regarding her diet, she eats free-from cereal in the morning, for lunch she has bread with marmalade, and for dinner she has rice and chicken. Since her iron deficiency anaemia diagnosis, she has been eating three times a day and has found her weight to be gradually increasing.

She doesn't have any gastrointestinal symptoms of note and her bowels are completely normal.

We discussed that iron deficiency anaemia carries a risk of malignancy (around 10%), however her reassuringly normal qFIT test and alternative explanation for iron deficiency in the form of dietary deficiency reduces this risk significantly.

She is not keen to pursue invasive investigations such as endoscopy. We discussed CT scanning with two days of prep but she declined due to potential bowel effects. I explained that despite being 84, she would be a candidate for keyhole surgery if large bowel cancer were detected, but she feels this is unlikely given her restricted diet devoid of vitamin C and iron-containing foods.

Regarding iron replacement, she has been completely intolerant of iron preparations previously. I discussed ferric maltol which is usually well tolerated. She is willing to try this at 30mg daily, potentially increasing to 60mg BD if well tolerated. She is welcome to contact me if not tolerating the medication, if haemoglobin doesn't improve, or if she wishes to pursue investigations. Iron infusion remains available as an alternative.

I have not booked her back to clinic but she may contact us as needed.

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