Transcription - 20250708T 11-06.mp3

Next patient is leah ugaldi a alpha381905 diagnosis abdominal pain mainly around defecation uncontrolled heartburn and early satiety with associated weight loss investigations ogd 20 25 normal thoracic sound normal celiac screen normal h pylori normal q fit normal faecal calprotectin 116 past medical history fibromyalgia hysterectomy and bilateral salpingo oophorectomy cholecystectomy soft tissue abnormality on mri leg awaiting repeat mri as discussed in sarcoma mdt olinoscopy may 2025 2 less than 5 mm subpedunculated polyps in the sigmoid excised 1 less than 5 mm subpedunculated polyp in the rectum excised histology should say endoscopic findings mild erythema from splenic flexure to rectum no loss of vascular pattern histology sigmoid polyps cesar serrated lesion without dysplasia rectal polyp benign hyperplastic polyp terminal ileal biopsies normal histological limits colomic biopsies preserved granular architecture no increase in intraepithelial lymphocytes normal cellular lamina propria no dysplasia of malignancy no infective organisms no significant pathological abnormality mucocaprojectin march 2025 a hundred and 16 fecal caprojectin february 2025 a hundred and 63 the ogd was in january 2025 normal mucosal appearances due to no histology normal hello hi that missus leo galday hi my name is doctor rob miller I'm 1 of the gastroenterology registrars here at daraford hope I've caught you at a reasonable time sorry I'm a bit late how are you okay you've got used to it yeah fine and what is it you've got used to the reflux no I know you've been doing you've been seeing plastics lately but yeah that's okay yeah right you're coughing it up k and you've been noticing that for how long what for since november 5 okay so since november you've been feeling chesty ringing at the yellowy sputum mhmm mhmm and in terms of your reflux symptoms how are they mhmm in what way do you feel acidy tell me like what what are your symptoms okay got heartburn yeah like symptoms with burning behind your breast pain do you get acid coming up into the back of your mouth mhmm right mhmm mhmm do you get a a loud feeling from your tummy and then how are your bowels yeah some some laxido the macroglove you'll change your diet when your bowels get worse yeah and do you find that helpful yep mhmm and what starts right so you become suddenly constipated and there's no clear dietary trigger for the constipation that comes on quickly but then tell me about the laxity you said you stopped that why did you stop that yeah yeah certainly they're better tolerated mhmm right yeah right okay so certainly I know what they mean in terms of the lacido and how it can it's obviously often better to have some food things like flaxseed and chia seeds as you're trying but if they cause you pain because of the fibre in them sometimes we can have sort of very sensitive guts and the stretch feeling that fiber gives some people makes gives them terrible pain and it sounds like that's from you because those foods are very fiberous and causes you pain have you ever tried things like senecot and senna mhmm yeah mhmm mhmm oh good oh yeah mhmm oh good yeah oh brilliant need some of that yeah that sounds really good some something just every we usually suggest taking it in the evening it works really well overnight and then usually people will have a nice bowel motion in the morning from center so so try that 15 mg is the dose I can ask a gp to add it to your repeat prescriptions mhmm brilliant so I'll ask your gp to add it to your repeat prescriptions if things don't work from the sennachol there are other medicines that we've got which work in ways that we don't really understand for people like yourself with an ibs predominant constipation and they can be really transformative but if we can get if we can do it with senna even better because less medicines and senna's quite natural it's quite nice so yeah so if if senna's working then fantastic if it doesn't work then get back in contact with us and then we can arrange to see you and start you on some another medicine called enucleotide which works really well for ibs with predominant constipation but for now if senna senna's working then great that sound alright brill I think it probably is the cause of everything because certainly your upper gi endoscopies have been reassuring in the past as a cause for significant reflux if you're really bunged up lower down you're gonna struggle to get things into your small intestine if you're very constipated so then you get nasty reflux symptoms it kind of all makes sense doesn't it yeah yeah of course yeah yeah good it doesn't usually affect the gut it acts very centrally so we don't find that that causes too much constipation thankfully but yeah so so that's what I'd suggest is we is try some center I'll put you on our sort of patient initiated follow-up so you can call us anytime over the next 12 months and we can book you see you again and start you on some which work can work really well if the center isn't working for you does that sound good no you don't have to go to the gp just call the secretary's which is the number at the top of the letter and we'll just book you the next appointment that we've got which is usually just in a couple of weeks' time to see you again so you don't have to go back to the gp is that alright wonderful great no worries at all good alright great well I'm glad you're feeling better and like you said your colonoscopy is very reassuring as I'm sure you know I'm sure they explained to you the time you had a few polyps taken off but you don't need to do it again you'll be happy to hear alright bro nice to talk to you oh yeah go on of course you mean you could if you wanted I mean I think it's a short term fix I don't think don't think unless you're gonna have an enema every day what we what you need is something that you take every day that works for you that you can get in a nice rhythm with your bowels and I feel like an enema is gonna be 1 of those things that you might want to have at a crisis. But if I were you I wouldn't want to be having an enema every day probably not very pleasant way to spend your day every day and having something that's natural that works sort of in a consistent manner is gonna be the way to do it that sounds a lot yeah yeah of course oh I no worries nice to talk to you okay thanks bye bye bye bye you okay I just use a computer of course yeah you're more than welcome to now

Diagnosis:
Functional dyspepsia with early satiety and weight loss
IBS with predominant constipation
Gastro-oesophageal reflux disease

Other Medical Diagnoses:
• Fibromyalgia
• Hysterectomy and bilateral salpingo-oophorectomy
• Cholecystectomy
• Soft tissue abnormality on MRI leg - awaiting repeat MRI as discussed in sarcoma MDT

Current Medications:
• Laxido - patient discontinued due to tolerability issues
• Senna 15mg PO nocte - STARTED TODAY

Investigations:
• OGD (January 2025): Normal mucosal appearances, no histology required
• Thoracic CT (2025): Normal
• Coeliac screen: Normal
• H. pylori: Normal
• qFIT: Normal
• Faecal calprotectin (March 2025): 116 μg/g
• Faecal calprotectin (February 2025): 163 μg/g
• Colonoscopy (May 2025): 2 subpedunculated polyps <5mm in sigmoid colon excised, 1 subpedunculated polyp <5mm in rectum excised. Endoscopic findings: mild erythema from splenic flexure to rectum, no loss of vascular pattern. Histology: sigmoid polyps - sessile serrated lesion without dysplasia, rectal polyp - benign hyperplastic polyp, terminal ileal biopsies - normal, colonic biopsies - preserved crypt architecture, no increase in intraepithelial lymphocytes, normal cellular lamina propria, no dysplasia or malignancy, no infective organisms, no significant pathological abnormality

Management Plan:
1. Trial of Senna 15mg nocte for constipation management
2. Patient initiated follow-up available over next 12 months if Senna ineffective
3. Consider linaclotide if Senna proves inadequate for IBS-C symptoms
4. Continue dietary modifications as tolerated
5. Monitor reflux symptoms - likely secondary to constipation

I had the pleasure of speaking on the phone to Mrs Ugaldi in gastroenterology clinic.

Mrs Ugaldi continues to experience abdominal pain mainly around defecation, uncontrolled heartburn and early satiety with associated weight loss. She has been experiencing productive cough with yellow sputum since November. Her reflux symptoms include heartburn with burning retrosternal pain and acid regurgitation. She reports intermittent constipation without clear dietary triggers, followed by periods of loose stools. She had been taking Laxido but discontinued this due to tolerability issues. She has tried dietary modifications including flaxseed and chia seeds but these caused significant pain, likely due to the high fibre content causing gut sensitivity.

Her recent investigations have been reassuring with normal OGD in January 2025, normal coeliac screen, H. pylori and qFIT. Faecal calprotectin levels have been mildly elevated at 116-163 μg/g. Recent colonoscopy in May 2025 showed benign polyps which were removed with reassuring histology showing no dysplasia or malignancy.

I have started her on Senna 15mg nocte which should help with her constipation. I suspect her reflux symptoms are secondary to the constipation causing delayed gastric emptying. I have arranged patient-initiated follow-up over the next 12 months should the Senna prove ineffective, at which point we can consider linaclotide for IBS with predominant constipation. I will write to her GP to add Senna to her repeat prescriptions.

Summary

Investigations

Plans