GI Follow up - General patient

Emma was called from the Gastroenterology research and consultation clinic. Chart reviewed (history of presenting complaint, family and past history, and laboratory investigations). Reviewed procedure: - Colonoscopy performed on 15 October 2024 for chronic abdominal pain and altered bowel habits. - Findings included diffuse mucosal erythema in the distal colon and several small, sessile polyps (<5mm) in the sigmoid colon. No active bleeding or strictures observed. Biopsies: - Biopsy results revealed mild chronic non-specific inflammation in the distal colon. Polyps were identified as benign hyperplastic polyps with no dysplasia. Current status: Patient reports significant improvement in abdominal pain since initiating a low-FODMAP diet. Bowel habits have normalised, with 1-2 soft, formed stools per day. No further episodes of rectal bleeding or weight loss. Patient tolerating diet well. Assessment and plan: - Continue low-FODMAP diet. Consider gradual reintroduction of foods after 3 months to identify specific triggers. - Prescribe a 3-month course of Mebeverine 135mg three times daily for symptomatic relief of abdominal discomfort if required. - Schedule a repeat colonoscopy in 5 years due to family history of colorectal cancer (father diagnosed at age 65). - Provide patient with educational materials on IBS management and dietary modifications. The patient understood and acknowledged the information provided and discussed today. This follow-up replaced the need to see this patient in person.