GI post procedure follow up

Date: 2025-12-17

INTERVAL:
The patient has been experiencing chronic diarrhea, which is controlled with daily cholestyramine and loperamide, though increasing dosages are required. Without these medications, the patient experiences severe, watery diarrhea throughout the day, including nocturnal episodes, and crampy abdominal pain. On the current regimen, the patient averages one bowel movement per day. There is concern about the long-term use of current medications and interest in alternative therapies.

They had an upper endoscopy and colonoscopy recently for evaluation of chronic diarrhea. Upper endoscopy demonstrated mild nonspecific gastritis. Colonoscopy demonstrated no significant findings. Biopsies results show no evidence of bacterial infection, acid reflux changes, celiac disease, malabsorptive disorder, parasites, or bacteria. Colonoscopy biopsies were within normal limits with no evidence of microscopic colitis or inflammation.

Work-up performed includes upper endoscopy, colonoscopy with biopsies, small bowel biopsy, and CT scan (April), all of which were normal except for mild nonspecific gastritis.

CURRENT MEDICATIONS:
Cholestyramine 8 grams daily (two 4-gram packets in the afternoon)
Loperamide 8 mg daily (4 mg in the morning and 4 mg at night)

INTERVAL INVESTIGATIONS:
Upper endoscopy: Mild nonspecific gastritis, no evidence of bacterial infection or acid reflux changes.
Biopsies: No celiac disease, no malabsorptive disorder, no parasites, no bacteria.
Colonoscopy: No evidence of microscopic colitis or inflammation; biopsies within normal limits.
CT scan (April): Normal findings.

ASSESSMENT AND PLAN:
The patient is seen for chronic diarrhea with normal upper and lower endoscopic findings, normal small bowel biopsy, and normal imaging. Mild nonspecific gastritis is present but not explanatory for symptoms. Symptoms are well controlled with cholestyramine and loperamide, but require increasing doses. Most likely diagnosis is irritable bowel syndrome with diarrhea predominance (IBS-D). Additional laboratory investigations have been ordered to exclude rare secretory causes of diarrhea. A trial of eluxadoline (Viberzi) has been initiated for one month to assess efficacy and potential to reduce or discontinue current medications. Instructions have been provided for gradual tapering of cholestyramine and loperamide over two weeks after starting eluxadoline. Follow-up is scheduled in one month to assess response to new therapy and adjust management as needed.

I will see them again in 1 month. They have my office contact and know to contact sooner if required.

No dedicated GI follow-up has been arranged but I would be happy to see them again as needed.

Next appointment: 1 month

Sincerely,

Template Template Hub, 
Empathia Medical Group