Dear Doctor,

I am Rajesh, aged 40 years from Oachira working in Muscat. I am suffering from reflux esophagitis, Irritable bowel, chest burning and epigastriac discomfort since 2001. Treated by Dr. Devi Prasad at Holy cross, kottiyam for Pyloric channel ulcer and H Pylori during 2011.

Met Dr. Shine at AIMS, Kochi during Sep/Oct 2016. Test results are as follows

USG Abdomen – Fatty Liver grade 1. Focal fat sparing liver left lobe.

Upper GI endoscopy
Esophagus - LAX LES, mucosal break in the lower end less than 5m.m.
Duodenum – D1 – Normal, Mild difficulty in passing the scope to D2 junction.
D2 – Normal.
Impression – LAX LES, LA - A Reflex esophagitis, CLO-Ve.
CT Abdomen contrast
Doubtful mucosal thickening noted along the medial wall of D2 and D3 junction of duodenum. ? Malignancy. Advised for endoscopic/histopath correlation.
ODG + EUS Diagnostic
Endoscopy procedure Report
Esophagus – Normal
Stomach – Erosion noted in antrum ? site of previous biopsy
D1 – Normal. D1, D2 junction was mildly edematous and negotiated with mild difficulty. D2 normal. Biopsy taken from D1 D2 junction.

Biopsy Report
Clinical Impression _ Edematous mucosa D1-D2 junction
Microscopic description - Multiple fragments show duodenal mucosa with brunner’s glands. One of the fragment shows surface hemorrhage.
There is no evidence of villous atrophy, increased in intra-epithelial lymphocytes, active/significant chronic inflammation or giardia or granuloma or malignancy.
Diagnosis – D1-D2 junctional biopsy – Descriptive.

Other Test – Stool – Blood, Mucus, Parasites – NIL, Occult Blood, Stool - Negative
CRP Ultrasensitive – 9.93 mg/L
RBC count blood – 4.45 M/uL
RDW Blood – 11.3%
Creatinine – Serum – 1.15 mg/dl
ALT SGPT- serum – 59.6 IU/L
Cholesterol total- serum – 256.9 mg/dl
Triglycerides – serum – 211.3 mg/dl
Cholesterol HDL serum – 45.9 mg/dl
Cholesterol LDL – serum – 188.9 mg/dl
Cholesterol VLDL – 42 mg/dl
Mono Blood – 10.4%
MCV Blood – 86.1 fL
ECG, 2D Echo, Transthoracic Treadmill – Negative for ischemia.

Medicines

Yogut – 1-0-0
Rosuvastatin – 0-0-1
Nebicard – 1-0-0

I am still suffering with gastric problems, heaviness in stomach, stomach pain, irritable bowel and discomfort.
Kindly advice any surgery is required. Submitted for your valuable opinion please.

Regards,
Rajesh.M
00968 0000
Whatsapp – 00 968 0000




Dear Doctor,

I am Rajesh, aged 40 years from Oachira working in Muscat. I am suffering from reflux esophagitis, Irritable bowel, chest burning and epigastriac discomfort since 2001. Treated by Dr. Devi Prasad at Holy cross, kottiyam for Pyloric channel ulcer and H Pylori during 2011.

Met Dr. Shine at AIMS, Kochi during Sep/Oct 2016. Test results are as follows

USG Abdomen – Fatty Liver grade 1. Focal fat sparing liver left lobe.

Upper GI endoscopy
Esophagus - LAX LES, mucosal break in the lower end less than 5m.m.
Duodenum – D1 – Normal, Mild difficulty in passing the scope to D2 junction.
D2 – Normal.
Impression – LAX LES, LA - A Reflex esophagitis, CLO-Ve.
CT Abdomen contrast
Doubtful mucosal thickening noted along the medial wall of D2 and D3 junction of duodenum. ? Malignancy. Advised for endoscopic/histopath correlation.
ODG + EUS Diagnostic
Endoscopy procedure Report
Esophagus – Normal
Stomach – Erosion noted in antrum ? site of previous biopsy
D1 – Normal. D1, D2 junction was mildly edematous and negotiated with mild difficulty. D2 normal. Biopsy taken from D1 D2 junction.

Biopsy Report
Clinical Impression _ Edematous mucosa D1-D2 junction
Microscopic description - Multiple fragments show duodenal mucosa with brunner’s glands. One of the fragment shows surface hemorrhage.
There is no evidence of villous atrophy, increased in intra-epithelial lymphocytes, active/significant chronic inflammation or giardia or granuloma or malignancy.
Diagnosis – D1-D2 junctional biopsy – Descriptive.

Other Test – Stool – Blood, Mucus, Parasites – NIL, Occult Blood, Stool - Negative
CRP Ultrasensitive – 9.93 mg/L
RBC count blood – 4.45 M/uL
RDW Blood – 11.3%
Creatinine – Serum – 1.15 mg/dl
ALT SGPT- serum – 59.6 IU/L
Cholesterol total- serum – 256.9 mg/dl
Triglycerides – serum – 211.3 mg/dl
Cholesterol HDL serum – 45.9 mg/dl
Cholesterol LDL – serum – 188.9 mg/dl
Cholesterol VLDL – 42 mg/dl
Mono Blood – 10.4%
MCV Blood – 86.1 fL
ECG, 2D Echo, Transthoracic Treadmill – Negative for ischemia.

Medicines

Yogut – 1-0-0
Rosuvastatin – 0-0-1
Nebicard – 1-0-0

I am still suffering with gastric problems, heaviness in stomach, stomach pain, irritable bowel and discomfort.
Kindly advice any surgery is required. Submitted for your valuable opinion please.

Regards,
Rajesh.M
00968 0000
Whatsapp – 00 968 0000