Physician's Assistant

Patient Details

Refined clinic letter (94 days ago 10:33)

Refined clinic letter Fri 02 January 2026 10:33

Last Modified: 94 days ago

MRN:

Content:

Diagnosis:
Recurrent GI bleeding likely secondary to peptic ulceration in the context of positive H pylori

Other Medical Diagnoses:
• Upper GI bleed due to peptic ulcer - October 2024
• Primary hyperparathyroidism - parathyroidectomy June 2025 for parathyroid adenoma
• Left breast cancer - treated with neoadjuvant chemotherapy, mastectomy and radiotherapy 2024
• Hepatitis B - treated 2014

Investigations:
• Upper GI endoscopy (October 2024): Helicobacter pylori negative, clean based pyloric ulcer
• Upper GI endoscopy (December 2024): Ulcer healed
• Ferritin: 44
• Full blood count: Hb 140, MCV 75.8 (microcytosis without anaemia)
• qFIT test: <5
• H pylori stool antigen test (October 2025): Positive - treated with one week eradication therapy

On examination: Height 155cm, weight 52kg.

Management Plan:
1. Upper GI endoscopy (requested) with recheck of H pylori status
2. Blood tests today to recheck haemoglobin and urea 
3. Consider long-term PPI treatment following endoscopy
4. Write with results

I had the pleasure of meeting Mrs Thunchanok in iron deficiency anaemia clinic today on behalf of Dr Powles. The consultation was face to face and she was accompanied by her partner.

It sounds as though she has had an episode of melaena 6 to 8 weeks ago which lasted 3 to 4 weeks and was associated with epigastric pain. Reassuringly this has now resolved and she is passing brown stools. She had some blood tests with you which demonstrated microcytosis but without anaemia and she also had an H pylori stool antigen test which was positive. Thank you very much for prescribing her one week of eradication treatment for that. Her upper abdominal pain has resolved which is reassuring.

In terms of her life more generally she works as an elderly carer, she doesn't drink or smoke, she goes to the gym 5 times a week.

We discussed today that it is likely that she has had further peptic ulceration secondary to Helicobacter pylori and we would suggest a further upper GI endoscopy in order to investigate this in more detail as well as considering long-term antacid treatment as advised in the previous endoscopy back in October to prevent any further ulceration. We could recheck her H pylori at this time as she has been off PPI now for one month and if this is positive we could prescribe further second-line eradication treatment.

She is reluctant to have an upper GI endoscopy which is understandable because she says that her last endoscopy where she received 75 micrograms of fentanyl and 3mg of midazolam she was dizzy on her feet afterwards and vomited several times. I would suggest that we give her lighter sedation this time in order to prevent any sedation-related side effects.

In addition to the upper GI endoscopy which I will request for her two-week-wait, she is also going to have some blood tests today to recheck haemoglobin and her urea and I look forward to seeing the results of these.

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Refined clinic letter (94 days ago 10:01)

Refined clinic letter Fri 02 January 2026 10:01

Last Modified: 94 days ago

MRN:

Content:

Diagnosis:
Recurrent GI bleeding likely secondary to peptic ulceration in the context of positive H. pylori - January 2026

Other Medical Diagnoses:
• Upper GI bleed due to peptic ulcer - October 2024
• Primary hyperparathyroidism - treated with parathyroidectomy June 2025
• Haemoglobinopathy
• Duodenal ulcer
• Left breast cancer - treated with neoadjuvant chemotherapy, nipple and skin sparing mastectomy with implant reconstruction and axillary node clearance 2023, radiotherapy 2024
• Hepatitis B - 2014

Current Medications:
• Omeprazole - DISCONTINUED one month ago
• H. pylori eradication therapy - COMPLETED (two courses of antibiotics)

Investigations:
• Upper GI endoscopy (October 2024): Helicobacter pylori based pyloric ulcer
• Upper GI endoscopy (December 2024): Ulcer healed
• Ferritin: 44
• Full blood count: Hb 140, MCV 75.8 (microcytosis without anaemia)
• FIT test: <5
• H. pylori stool antigen test (October 2025): Positive
• Gastric biopsies (October 2024): No Helicobacter pylori detected

Management Plan:
1. Upper GI endoscopy - 2 week wait referral
2. Blood tests today to recheck haemoglobin and urea
3. Consider long-term PPI therapy following endoscopy
4. Recheck H. pylori status during endoscopy (off PPI for one month)
5. Second-line eradication therapy if H. pylori still positive
6. Next appointment - post-endoscopy review in 2-3 weeks

I had the pleasure of meeting Mrs Thunchinok in gastroenterology clinic today. The consultation was face-to-face and she was accompanied by her partner.

She reports an episode of melaena 6-8 weeks ago which lasted 3-4 weeks and was associated with epigastric pain. Reassuringly this has now resolved and she is passing brown stools. Blood tests demonstrated microcytosis but without anaemia. H. pylori stool antigen test was positive and she has completed two courses of eradication treatment.

Her upper abdominal pain has resolved and her stools have returned to normal colour, which is reassuring regarding ongoing bleeding. She works as an elderly carer, doesn't drink or smoke, and maintains excellent fitness attending gym 5 times weekly with performance status 0.

O/E: Height 155cm, Weight 52kg, BMI 21.6

We discussed that she likely has further peptic ulceration secondary to Helicobacter pylori. I have arranged urgent upper GI endoscopy to investigate further and consider long-term antiacid treatment as previously advised. She is reluctant regarding endoscopy due to previous experience with oversedation (75 micrograms fentanyl and 3mg midazolam) causing prolonged dizziness and vomiting. I have suggested lighter sedation this time.

Given her complex medical history including recent breast cancer treatment and the challenging nature of H. pylori eradication, close monitoring is essential to ensure complete treatment and prevent recurrence.

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Summary:

Investigations: