Next patient is thomas elliot e l l I o t t alpha408104 28 year old gentleman anthropometry bmis 18 blood pressure 125 over 75 nonsmoker pulse 59 past medical history none current medication none investigations stool culture may 2025 negative for campylobacter salmonella shiga toxin shigella cryptosporidium and giardia fecal calprotectin 261 may 2025 bloods may 2025 crp 55 neutrophilia 9.6 with white cells 14.1 monocytosis 1.14 eosinophilia 0.81 platelets 478 hi is that mister thomas elias hi my name is doctor robert miller I'm 1 of the gastroenterology doctors at great care of fit how are you good like yeah very good thank you have I caught you at a reasonable time good I'm glad ready to get out in the sun I bet after this yeah isn't it gorgeous yeah but anyway I I note that your gp so I've read the letter from your gp about why they wanted us to see you in clinic I'd love to hear a little bit about your symptoms what's been troubling you and we can work out what to do about it is that alright mhmm yep mhmm mhmm mhmm okay mhmm mhmm force okay mhmm mhmm mhmm fair enough it sounds really debilitating symptoms I'm sorry of course and any eye symptoms yeah sometimes people tell me they get very painful red eyes nothing like that no any rashes yeah and any lower back pain mhmm alright yeah and do they are they around your knee or bum or are they they're on the front k yeah and the folds of skin top of your legs yeah I understand yeah I don't think that'd be related to inflammatory bowel disease it's strange though isn't it and any rashes on your shins lots of people describe rashes no good and lower back pain okay and where's the pain mhmm yeah fine and okay and in your butt not in buttocks fine and then tell me about the pain let's talk about that so you said it's in your lower tummy mhmm and does it come to a kind of crescendo in that time it gets more and more and more and then it suddenly stops yeah mhmm and if you pass a stool does that change the pain okay fine okay and it's a long time to have symptoms anyone else ill no any recent travel mhmm where did you go teneree fine course and do you have a family partner what's your life like more generally mhmm how old's your kid good they're well good and do you work what do do for a living mhmm do you do you physically do that security or do you get someone to do it for you yeah yeah fuck still must be tough though with your symptoms in and out of the office all the time to the note okay good nice alright fine and have you been losing weight at all recently mhmm mhmm mhmm in about the same birth time 6 months or less than that mhmm yeah fine and any family history of anything you're thinking about your parents or uncles no inflammatory bowel disease in the family and have you done some googling do you have any ideas about what it is lots of people do yeah fair enough of course yep that's why my job is so interesting because it's very it's very you know hard to nail down exactly what's causing things and it does sometimes take time yeah but and have you has your gp told you about your blood test results and your stool test results and things like that okay yeah yeah they have mhmm mhmm you're right yeah that your markers of infection and inflammation are raised in both the blood tests that you had back in may so early may your crp which is a marker of inflammation in the blood is was high on both of those as well as your platelets and neutrophils which all go towards inflammation something being inflamed and unhappy causing this they could also come up with infection your gp did a stool test slip for infection there's no common infected bugs and it would be a bit strange to have an infection for that amount of time you had the blood test for coeliac disease which you don't have so cutting out gluten is not going to help your symptoms there is a very small subset of people that don't respond to the blood test that don't have a blood test positive even though they've got celiac disease but they'd be incredibly unlikely and it wouldn't I think be unlikely to cause the symptoms that you described and then you had the stool test for inflammation in the stool and that came back a little bit high not crazy high but a little bit high so all those things together with your symptoms and your test results. Us towards inflammation somewhere probably inflammation in the bowels given your symptoms are in the bowels and the stool test is high and I guess you've done lots of googling about what that could be yeah completely yeah so there's things inflammatory bowel diseases which are not very common but if you're going to get them this would be the time in life that you would get them in your sort of mid-20s to mid-30s would be the very classic time to develop them we're not sure what causes them we suspect that there's some imbalance in the gut flora in the microbiome and in the gut and your body recognises some of those bacteria as foreign starts to become inflamed and angry and attack your own bowel and that can cause lots of things it can cause terrible symptoms that you describe with loose watery stools and tummy pain it can cause narrowings in the bowel where the bowel becomes scarred and that can lead to the pain that you described it can lead to passing blood or mucus with your poo you haven't told me that you've had any of those symptoms mucus okay it's like egg whites like a like like a kinda like a cooked egg white like like a kinda what kind of stuff have you passed the okay in the in terms of its color or in terms of its like texture or yeah yeah okay fair enough and yeah so there can be there can be a couple of things that can cause it things like inflammatory bowel disease is always a possibility and investigating that in someone like yourself with raised blood tests and symptoms I think is very sensible the test that I would suggest to look for that would be a colonoscopy so that's when we give you some strong laxative medicine clear out your bowels and then a couple of days later go with our camera it takes about 15 20 minutes while we're inside but the prep before takes days we look in with our camera we look at all the lining of your: and the last part of the small intestine we take some samples from all of that to look for inflammatory bowel disease that will help us work out if there's inflammation in your: or in the last part of your small bowel which is the most common place that crohn's disease which is a type of inflammatory bowel disease affects we won't be able to see other than the last part of the small intestine the rest of the small intestine with that test and so I also suggest an mri scan of your small intestine so you drink some contrast contrast which helps us distend the small bowel open it up so that we can get a good view of the walls of the small bowel and we'll look at those pictures with the specialist radiologist and think about whether there might be any sign of inflammation in the small intestine and those 2 things together will help us ascertain whether there's any inflammation in your gut it may be that that's what's causing things it may not be that that's what's causing things but I think it's really important for someone like yourself definitely someone with blood tests that are elevated to investigate that sound reasonable any questions about that or anything like that fine you haven't had any blood tests now in over a month mhmm yeah the may 12 is is I've got you had stool tests at the may the may 27 by the way so yeah I'll I'll ask you I'll ask your gp to offer you some more blood tests or I can put some on our requesting system and you can come to windsor house which is just near the hospital to have them done just a few more tests just to look for any other things that can cause you to have loose stools I'll check your thyroid function I'll check your calcium levels things like that and I'll also test you for bugs that can be reactivated by immunosuppressive medicines when if we're worried about people with crohn's disease or and the inflammatory bowel disease the mainstay of our treatment is to depress suppress the immune system slightly and so it's sensible to make sure we haven't got any viruses lingering in the background that we can reactivate with our immunosuppressive medicine so it would be pretty does that sound okay brilliant fine anything I've forgotten or any questions or anything like that bruh of course you can I've put them on the system now and they'll be ready immediately so you can go today so that's done and then I'll write to you the results when I get them through get the prep through which doesn't taste very nice but does work really well so you clean out the bowel to make sure we get good views and then after that you'll get an appointment for the colonoscopy our colonoscopy waiting list is very good at the moment so you'll with us in a couple of weeks time getting that done hope the results are okay brilliant any any metal implants in the body a pacemaker anything in your head any clips just thinking about the mri as a strong magnet so we don't want to dislodge anything great brilliant I'll arrange those things to me and look forward to seeing the results we'll talk to you in clinic within 6 weeks time with the results is that okay nice to talk to you bye bye so the plan is number 1 mri of the small bowel urgently number 2 colonoscopy with seroclonic biopsies and tubular il intubation urgently number 3 follow-up with results in 6 to 8 weeks number 4 blood tests including preimmunologic screening taken at windsor house today did gp have the pleasure of speaking on the telephone to mister elliot in gastroenterology clinic today on behalf of doctor klimova full stop <\n\n> Many thank you many thanks for referring him to us full stop <\n\n> I was sorry to hear about the symptoms he's been experiencing for the last 6 months with loose stools passing a type 5 to 6 stool without blood 3 to 4 times during the day and up to 5 to 6 times at night associated with this he's had some systemic symptoms in the way of fatigue and weight loss over 1 and a half stone over the last 6 months full stop he doesn't describe any eye or skin symptoms but does experience low back pain which tends to peak when his when he has abdominal pain full stop <\n\n>