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Clinic letter (311 days ago 11:45)

Clinic letter Fri 30 May 2025 11:45

Last Modified: 311 days ago

MRN:

Content:

Diagnosis:
Left-sided ulcerative colitis diagnosed 2022

Other Medical Diagnoses
None mentioned

Medications:
**5-ASA suppositories (newly started)**
**Clipper course 5mg OD for 43 weeks. (newly started)**

Investigations:
Colonoscopy June 2022: Moderate mucosal erythema and friability, contact bleeding, loss of vascular pattern and erosions from insertion to the proximal descending colon. The rest of the colonic mucosa and ileum look normal with a very small patch of inflammation in the caecum. Moderate distal ulcerative colitis Mayo score 2.
Histology 2022: Terminal ileal biopsies - small intestinal mucosa with normal villous architecture, no increase in lymphocytes, active inflammation or granulomas within normal histological limits. Colonic biopsy series - mild to moderate active chronic inflammation with crypt abscesses in more inflamed areas in keeping with active chronic inflammatory bowel disease.
Bloods 2022: High platelets, anaemia, iron deficient.

Plan:
1. Flexible sigmoidoscopy - 2 week wait
2. Course of steroids - Clipper
3. Bloods for Pre-immunologic screening and flare
(FBC, UE, LFT, CRP, Cholesterol, TSH, TPMT, CMV (IgG and IgM), EBV (IgG and IgM), VZV (IgG and IgM), Hep B Core and surface, Hep C Antibody, Hep A, HIV)
4. Consideration of systemic treatment with results of pre-immunologic screen, flexible sigmoidoscopy and blood tests
5. Trial of 5-ASA suppositories
6. Ensure up to date with cervical screening
7. CXR as part of pre-immunologic screening
8. Vaccinations: Influenza and pneumococcus

I had the pleasure of speaking on the telephone to Mrs Froude today on behalf of Dr Hayward in IBD clinic.

She was diagnosed with left-sided ulcerative colitis in June 2022. She required steroids at her initial diagnosis and subsequently started on Octasa 2.4g. Unfortunately, she found the Octasa gave her diarrhoea, which I explained can sometimes happen with this medicine, and so she was not able to take it and stopped it.

Since then, she's had good and bad days with occasional stomach cramps and occasional loose stools, however something that she finds tolerable.

Unfortunately, over the last 4 to 6 weeks she's been having significant urgency after eating, passing a watery type 7 stool with occasional visible blood 6 times a day. She hasn't had any fevers but she is feeling tired and lethargic alongside it.

She's noticed that she's lost some weight over the last few months, her clothes are looser, but she doesn't weigh herself and she's avoiding food because she lacks an appetite and also because she's trying to improve her symptoms by restricting.

In terms of her life more generally, she has 3 young boys and works a desk job from home most of the time, however is required to go into the office occasionally, which she understandably finds difficult given her bowel habit.

She doesn't smoke and doesn't drink alcohol excessively.

We discussed today that it's likely that she's had ongoing bowel inflammation for some time and it doesn't sound like we've ever got complete control of it apart from when we gave her steroids.

I explained that we want to control her symptoms in order to allow her to live a full life, but we also want to decrease bowel inflammation in order to decrease her risk of developing malignancy in the future.

Without any blood tests, she's a moderate on the Truelove and Witts criteria for flare of ulcerative colitis, and so I'll send her out some 5-ASA suppositories, which I hope will help her left-sided proctitis symptoms, as well as a course of steroids to dampen down any underlying inflammation. I'll request an urgent flexible sigmoidoscopy for her to assess her disease activity as well as some blood tests, and with these things we can establish whether escalation of treatment and consideration of thiopurines would be sensible for her given her intolerance to 5-ASA therapy.

I look forward to discussing with her again in 6 weeks' time with the results of investigations.

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Refined results letter (286 days ago 08:03)

Refined results letter Tue 24 June 2025 08:03

Last Modified: 286 days ago

MRN:

Content:

Plan:
1. Blood tests to be performed at Windsor House (walk-in service)
2. Follow-up appointment in clinic in a few weeks' time
3. Monitor ulcerative colitis activity and treatment response

Dear Patient,

I am writing to follow up the results of your flexible sigmoidoscopy and the biopsies taken at this time.

As the endoscopist explained, your flexible sigmoidoscopy showed signs of inflammation in the wall of your bowel indicative of a flare of your ulcerative colitis. The biopsies taken confirm that activity in your ulcerative colitis is what is causing your symptoms. Reassuringly, there are no sinister or worrying changes in these samples.

I do think getting some blood tests will be very sensible as I said at the time of clinic and I have made a request for you to have these performed at Windsor House which is a walk-in service near to the hospital.

I look forward to seeing the results of these as well as following you up back in clinic in a few weeks' time.

Yours sincerely,

If you have any questions or concerns about these results, please do not hesitate to contact us.

Summary of Results:
Flexible sigmoidoscopy: Mild to moderate inflammation consistent with ulcerative colitis flare
Histology: Active ulcerative colitis, no dysplasia

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