Table 1 Patient’s past medical history
1949Tonsillectomy and adenoidectomy
1985Alteration in bowel habit and colicky abdominal pain; rectal biopsy: spirochaetosis. Jejunal diverticulosis on barium follow through; raised faecal fat excretion
1986Duodenal biopsy: giardia in crypts and partial villous atrophy, weight 58.3 kg. Bacterial overgrowth syndrome (H2 breath test positive)
1988Recurrent abdominal pain, barium follow through: jejunal diverticulae. Duodenal biopsy: focal chronic duodenitis possibly related to past giardiasis, possible gluten enteropathy. Some improvement in abdominal symptoms with gluten free diet and cyclical antibiotics
1994Recurrent diarrhoea possibly secondary to bacterial overgrowth (treated with cyclical antibiotics)
1995Vitamin B12 185 ng/l—started on intramuscular B12 replacement
2000Recurrent diarrhoea, weight 56.5 kg, extensive diverticulosis—vitamin D and E deficient
2002Basal cell carcinoma on neck excised with clear margins
2003Persistent rectal bleeding and possible subacute intestinal obstruction. Viral pericarditis
2004Osteomalacia and osteopaenia, secondary hyperparathyroidism; parathyroid hormone level 216 ng/l (10–65), blood calcium 2.11 mmol/l (2.12–2.62)
2005Episodic diarrhoea, weight 53.4 kg, anaemia (haemoglobin 80 g/l, ferritin 9 μg/l, normal B12 and folate levels—transfused 2 units of red cells). Endoscopy, grade 2 oesophagitis, duodenitis, significant jejunal diverticulitis. Cyclical antibiotics for bacterial overgrowth. Herpes zoster ophthalmicus