My wife complained of painless blood in stool in june 2013. A colonoscopy with biopsy suggested chron's disease. Since then she was prescribed mesacol 400 mg thrice daily. However she took only 1 tablet per day for 2 years and that kept the problem in check. She got pregnant on september 2015 and was off mesacol for the duration of pregnancy. She delivered our baby via c section on june 2016 and since then was complaining of lose motion. She did not resume mesacol fearing interference with lactation. After 1 month of lose motion she started complaining of unbearable abdominal pain. We saw a gastroenterologist who suggested a few tests- USG whole abdomen, blood tests, fecal calprotectin and endoscopy (ugi, lgi and capsule). We did all the tests except endoscopy. Usg whole abdomen revealed nothing but fatty liver, blood test revealed high eosinophil and fecal calprotectin was 206. She was prescribed mesacol od 1.2 g twice daily and probiotics which she is taking now and has no problems now. My question is are all 3 types of endoscopy needed? What should be my future course of action?
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Upper, lower and capsule endoscopy, each has got its limitations. In upper and lower gastro intestinal endoscopy you cannot reach beyond a point and to visualize the small intestine beyond duodenum and jejunum, one needs the capsule which independently traverses the course of tract giving imaging signals of the interior of the small intestine. Now that she is not having any complaint on mesacol 1.2 gm bd, you don't need to do much. Calprotectin at 206 (ug/gm or mg/ kg of faeces) is higher than normal consideration but it is a general marker only to suggest ibd (inflammatory bowel disease)
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Yes all three endoscopies are required. Continue mesacol for disease supression.
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