(Age:
74 years, male)
In 1993, I had a triple bypass procedure. I had a hemoglobin (Hb) of 8 gm at discharge, and the Hb was very slow to rise despite taking oral iron. The Hb remained lowish, about 12 gm.
In 1994, I was investigated with an upper GI endoscopy and colonoscopy. The former showed a florid gastritis and the Aspirin dose was lowered from 325 mg to 80 mg.
A follow up gastroscopy showed no abnormality. Despite taking oral iron, my Hb remained in the region of 13 gm.
In 1996, I was again colonoscoped. This ? as a follow up as the Hb remained unchanged.
About a year later, I began to notice abdominal discomfort, which was centred largely in the upper abdomen along with slight feeling of nausea. My bowel habit for years had been intermittently costive (constipated). The symptoms were considered to be secondary to the diverticular disease.
In 1999, because of the persistent abdominal discomfort and the nausea, I was again referred to a GI specialist. Because of the persistent iron deficiency anemia, he undertook another colonoscopy. The findings were as before, only diverticular disease.
I continued with the oral iron, which I had been taking at this point for a number of years (thought to be possibly secondary to Aspirin). No explanation for the nausea was given. Symptoms of abdominal discomfort and nausea along with headache persisted.
In late 1999, I commenced to have diarrhea with watery brown stools, usually lasting a day and occurring every three weeks or so.
In May 2000, I commenced to have diarrhoea along with moderate abdominal discomfort. But instead of clearing after twenty-four hours or so, this persisted.
Whilst on a visit to the U.K. the diarrhea became suddenly worse, with watery stools which were now yellowish and very foul smelling. During this period I was taking Lomotil plus Tylenol (for the abdominal discomfort). After nearly three days the diarrhea stopped, but the stools were pale, putty colored and very soft.
A second bout of diarrhea occurred some three days later, with fecal incontinence lasting twenty-four hours and followed by ten days of pale yellow, soft stools. These symptoms precipitated return to this country for investigation.
Prompt referral to a GI specialist resulted in a barium meal and follow-through, which showed some dilatation of the proximal small bowel. Some weeks later a gastropcopy and biopsy was undertaken.
The diagnosis: total villous atrophy. This was at the end of June.
Following a gluten free diet, I have not experienced abdominal pain or nausea and the stools are normal. I am awaiting result of the recent blood results.
Of interest may be the fact that between 1972 and 1980 I had intermittent symptoms of a distal colitis (lower 12 cms, as noted on sigmoidoscopy). These symptoms were controlled for the most part by a combination of salazopyrine and Betnosol enemas.
In 1980, I had a sigmoidoscopy which was normal. I remained symptom free thereafter.
There is no history that I know of anyone having symptoms of celiac disease in my family. Apart from a paternal grandfather who died of carcinoma of the stomach and an elder brother who died of pancreatic carcinoma aged 70, there is no other GI disease.
