665043 investigations agd february 2025 normal mucosal appearances judenal histology gastric heterotopia but no other significant pathological abnormality lymphoid aggregates in the lamina propria have a well developed villous architecture ogd november 2024 normal mucosal appearances histology very slight villous blunting but without significant crypt hyperplasia and tttg february 2025 negative anti endometrial antibodies igg and iga negative february 2025 hla dq to testing positive bloods december 2024 eosin is normal lft is normal full blackout normal hi hi laura hi my name is doctor rawl no no I'm 1 of the gastroenterology registrars you're clear of bed hi have I caught you at a reasonable time right yeah how how are you doing feel about the same tell me about your symptoms at the moment mhmm okay and so how often will these episodes these random episodes affect you every 3 weeks mhmm and that affect you for the whole day and and those those symptoms that affect you for the whole day will be next to the toilet mhmm I see fine so you build up the imodium but it you know doesn't affect things and do you associate it with any dietary changes gluten or anything like that mhmm have you yeah you're you had the last endoscopy in the february yeah so you've been gluten free since then but the symptoms haven't got better fine and do you have tummy pain along with that okay k and when's the last time you remember your bowels being normal for you years as far as you can remember or or or not that long mhmm mhmm mhmm mhmm but you still get the symptoms yeah okay we'll see and obviously your colonoscopy is quite reassuring there wasn't any worrying signs there there was that tiny polyp which we removed yeah then you had the the and the samples from that polyp didn't show anything worrying in that polyp and the samples from the rest of your: were very reassuring in terms of inflammation of the: causing the symptoms and then there's been this latest investigations for coeliac disease and certainly the biopsies it's a bit of a challenging 1 because the biopsies taken don't show coeliac disease at all and the other blood tests don't show coeliac disease but they do show that you're at risk of coeliac disease because of 1 of the genetic tests that we've done however nothing else points towards coeliac disease does that kind of make sense yeah fine so I don't think coeliac disease is causing your symptoms it certainly would be very uncommon for it to cause the episodic nature of your symptoms I think doing some different stool tests would be quite helpful because I still don't think we've really nailed the diagnosis for what's going on here and I can see you've had lots of tests in terms of upper and lower gi endoscopies and a ct scan I think checking your stool to look for whether there's any inflammation there or whether there's any problems with the pancreas could be quite helpful and and I think that in addition with some up to date blood tests would be would be a sensible investigation to do for the moment and then and take it from there with those results is that okay anything I've forgotten or any questions or anything like that okay I'll send you out a pots and a lay and a form for the stool test to look for the pancreas and I will book you the blood tests which you can have taken at windsor house which is just near derek and I'll write you with the results and then come back is that okay I'm sorry we haven't really got to the bottom of it but I hope we will with a few more tests yeah I'm sorry yeah okay alright I look forward to writing you the results when they come back talk to you soon bye bye diagnosis change in malhabit and weight loss of uncertain cause for further investigation other medical problems hiatus hernia central hypertension peptic ulcer 2019 duodenal ulcer 2015 esophagitis 20 50 iron deficiency anemia 20 40 obesity 2000 medications list paracetamol 1 g up to 4 times a day for pain nebivolol 2.5 mg once in the evening citalopram 20 mg at night cholocalciferol 800 units in the morning lanzoprazole 30 mg twice a day loperamide as required investigations ct thorax abdomen and pelvis september 2024 no course for patient symptoms identified colonoscopy august 2024 sigmoid polyp sized but otherwise normal macroscopic appearances histology revealing sigmoid polyp tubular adenoma with low grade dysplasia only serial colonic biopsies large intestinal mucosa with occasional small reactive lymphoid aggregates but otherwise no significant abnormality plan stool test for fecal elastase updated blood tests clinic follow-up in 3 months had the pleasure of speaking on the telephone to miss fine in gastroenterology clinic today on behalf of professor lewis full stop I'm sorry to hear that she continues to experience loose stools opening of bowel several times a day with worsening in her symptoms can occur for 12 to 24 hours with vomiting associated with it full stop she says that her symptoms have been persisting like this for many years and she's quote beginning to get used to it quote full stop she was diagnosed with irritable bowel syndrome many years ago as it's been a very long time since she experienced a regular bowel habit full stop <\n\n> She has some occasional abdominal pain associated with this which is relieved by opening her bowels full stop <\n\n> She's been undertaking gluten free diet since her endoscopy in mid february but her symptoms remain the same full stop <\n\n> Explain today that her investigations don't show any sign of celiac disease and so she could continue to eat gluten if she wants full stop <\n\n> I don't think we found the underlying cause for her symptoms so I'll arrange a fecal elastase test as well as some up to date blood tests and follow-up in 3 months' time with the results of these full stop yours sincerely