Gastroenterology Masterclass

Michelle, a 23 year old lady, presents with a history of diarrhoea between 4 and 8 times per day.

It is associated with pain which is colicky and more left sided. This has been bad for the last 2 months following a holiday in Turkey. There has not been any blood or slime, and the diarrhoea is worst in the morning. It subsides later in the day.

She feels bloated when she eats food and thinks that gluten based foods upset her, so has reduced these in her diet with some improvement.

In the past she has been well, though as a teenager was admitted twice with possible appendicitis. Her appendix was not removed.

She works at the local supermarket and her employers are concerned that she has had time off due to diarrhoea. She recently broke up with her boyfriend after their holiday in Turkey, as she caught him texting her best friend and found out he had been cheating on her.

She uses imodium, bought over the counter, which does help the diarrhoea. She has now stopped the contraceptive pill.

On examination, she is tender on the left side. Rectal examination is normal with no blood.

Investigations show a normal FBC, viscosity 1.65, CRP of less then 5, and TTG of 1. Faeces culture is negative.

Questions

a) What is the likely diagnosis? Are there different types?

b) What criteria may be useful in helping you make a positive clinical diagnosis? Why is this important?

c) What other conditions can mimic this, and what tests may be necessary to exclude these conditions?

d) What options are there for treatment?