1, 【GASTROSCOPY & COLONOSCOPY REPORT】
Thank you for referring this 35-year old lady for simultaneous gastroscopy and colonoscopy.
INDICATION
Understand she has been troubled by left upper quadrant pain for 4 months and intermittent suprapubic pain for about 2 years. Bowel habit is normal. Her faecal calprotectin is persistently elevated at 3 9 2 mcg/g on both 2/7/2022 and 11/8/2022. Blood work-up on 25/6/2022 including FBC, CRP, ferritin, vitamin B12, folate, TSH and coeliac serology were normal/negative.
SEDATION & PROCEDURE Olympus gastroscope and paediatric colonoscope used. Scope guide and NBI imaging. Midazolam 3 mg, fentanyl 100 mcg, Xylocaine throat spray and Buscopan 10mg. MoviPrep
GASTROSCOPY
Tolerance of procedure was excellent although some discomfort occurred when the scope was passed into the duodenum. The Z-line is located at 36 cm. Both the minor and major polyps were identified and appeared normal. Examination was normal. Biopsies taken from the gastric antrum, gastric body and duodenum for histology.
COLONOSCOPY
Bowel preparation was satisfactory and good views were obtained into the terminal ileum. Intubation was straight forward and tolerance of the procedure was good. Rectal examination was normal. There was a 2 mm polyp in the distal ascending colon which was removed with cold snare technique and retrieved histology. In these upper sigmoid there was possibly very slight increase in vascular pattern without inflammation. The remainder of examination was normal. Biopsies were taken from the ileum, caecum, ascending, transverse, and ascending, sigmoid colons and rectum for histology to look for evidence of microscopic inflammation.
OPINION
1. Normal gastroscopy
2. Diminutive ascending colon polyp
3. Possible very mild inflammation in the upper sigmoid
FOLLOW UP
No clear cause for abdominal pain and increased faecal calprotectin identified. I will ask the patient to contact you for review in 7 to 10 days. I would suggest a repeat colonoscopy in 5 years to check for any new polyps.
2, 【FOLLOW-UP TO GASTROSCOPY & COLONOSCOPY REPORT】
I am writing by way of follow-up to my gastroscopy and colonoscopy report
As you know the gastroscopy was normal including gastric and duodenal biopsies. The colonoscopy revealed are diminutive polyp in the ascending colon which on histology revealed a focal active colitis with a mucosal granuloma (i.e. not a true polyp). There was a very slight increase in vascular pattern in the sigmoid colon. The ileal, transverse colon and rectal biopsies were normal but interestingly the biopsies from the ascending, descending and sigmoid colons all are longer of 5 lobular showed mild chronic colitis with paneth cell metaplasia although there was no increase in chronic inflammatory
cells.
The histological findings in the colon correlate well with her elevated faecal calprotectin of 392ug/g and are suggestive of chronic inflammatory bowel disease. The distribution is suggestive of Crohn’s disease rather than ulcerative colitis.
I would be happy to see her for formal review should you wish but I would suggest starting her on
Pentasa 3000mg to 4000mg a day. Monitoring of the degree of infection could be undertaken with
serial faecal calprotectin.
As you know she experienced persistent nausea, mild right lower quadrant pain and feeling shivery
after procedure and was assessed by you by request. I note that she was admitted briefly to North
Shore Hospital for assessment. The exact cause for symptoms is unclear but she was able to be
discharged the same day as her symptoms spontaneously settled. I spoke with patient the next day
and she was well.
3, 【Acupuncture for Crohn’s Disease】
Firstly, looking for the pressing pain points and areas in the back.
Then Putting needles in the back in bladder meridian, and bleeding cupping with special needle.
Waiting for the results after 3 sessions
【03/11/2022 】it is third treatments, patient tells me that the pain in the right lower abdomen disappear completely, but still feeling one time little tight while heavy lifting. The pain in the left up abdomen relief lots, the pain level is from 15 to 5, the frequency of the pain is from all day to 7 times a day, but only last 2 minutes a time. I will make a video when doing Next treatment. And I will tell you what my opinion is about the cases in diagnosis and treatments. Thanks
【20/11/2022】no right lower abdomen pain from last treatment, but still she still feel little pain in the left up abdomen twice a week, and only last 2-5 minutes/every time, the pain do not affect her normal living.
27/11/2022 patient left a review in the our google business.
she can feel pain in right lower abdomen, and 95% improvement in the left up abdomen after 5 sessions treatments.
4, 【my opinion about the case】
1), just depending on the【FOLLOW-UP TO GASTROSCOPY & COLONOSCOPY REPORT】, then diagnosis the Crohn’s disease. whether next time it would be diagnosed after a repeat colonoscopy in 5 years to check for a mucosal granuloma and faecal calprotectin .
I am writing by way of follow-up to my gastroscopy and colonoscopy report
As you know the gastroscopy was normal including gastric and duodenal biopsies. The colonoscopy revealed are diminutive polyp in the ascending colon which on histology revealed a focal active colitis with a mucosal granuloma (i.e. not a true polyp). There was a very slight increase in vascular pattern in the sigmoid colon. The ileal, transverse colon and rectal biopsies were normal but interestingly the biopsies from the ascending, descending and sigmoid colons all are longer of 5 lobular showed mild chronic colitis with paneth cell metaplasia although there was no increase in chronic inflammatory
cells.
The histological findings in the colon correlate well with her elevated faecal calprotectin of 392ug/g and are suggestive of chronic inflammatory bowel disease. The distribution is suggestive of Crohn’s disease rather than ulcerative colitis.
2), she has not the symptom of the Crohn’s disease EXCEPT the abdomen pain. such as diarrhea, blood in stool, nonreasoned fever, nonreasoned, weight lost.
3), the treatment’s effective is very good, no right lower abdomen pain after 2 sessions, and 95% improvement in the left up abdomen after 5 sessions treatments.
4), I had a examination in the her fist visit me, I found that there are pressing pain beside the spine and there are the sensitive area with needle in the left up abdomen and the right lower abdomen. (please see the above the video).
5), she started the Pentasa 3000mg to 4000mg a day, after being diagnosed the Crohn’s Disease, but it’s the side effect was too bad, so she did not take it.
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