UC Pseudopolyps Decoded, IBS-D Treatment Hacks & The CIPO Readmission Fix You Need

Jan 31, 2025

Weekly WhatsApp Group Digest:
January 22–30, 2025

Case 1: Elderly male with hematochezia

10-day hematochezia requiring 6-unit transfusion; rectal/sigmoid lesions observed.

Amoebic colitis (biopsy confirmation suggested; metronidazole initiated).
Infectious colitis vs. IBD (unlikely given short history in elderly + CT findings: rectal wall thickening without mural stratification).
Ruled out ischemic colitis (no pneumatosis) and rectal varices (EUS Doppler/CT angio recommended for vascular evaluation).

Case 2: UC with pseudopolyps

Caution against misdiagnosing pneumatosis intestinalis (NBI imaging clarified "blue" artifacts vs. true pathology).

Mesalamine:

Dose: 500 mg–2 g/day (escalate based on fecal calprotectin levels).
Combine with S. boulardii (4 weeks) + psyllium for synergistic effect.
Improvement timeline: 7–30 days (persistent cases may require neuromodulators or ondansetron for urgency).

Lidamidine: Proposed as alternative for refractory cases (limited evidence).

First-line: Psyllium + macrogol (1:1 ratio BID).
Adjunctive: L. acidophilus (10 billion CFU/day) + sodium picosulfate.
Non-pharmacologic: Squatting posture to optimize rectal angle during defecation.

Pancreatic Necrosis: Dual-modality approach with metal stent + percutaneous endoscopic necrosectomy for complex walled-off necrosis.
EUS Doppler: Critical in differentiating vascular vs. inflammatory rectal lesions.

CIPO Management: Consider rectal flatus tubes to reduce readmissions (evidence pending).
Pentasa Xtend 2g: Administer orally with water post-meal; no dissolution required.

Next Digest: February 6, 2025

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