Hello,
Welcome to icliniq.com.
I can understand it has been a tough time for you to undergo these repeat testing and endoscopic examination again and again.
In both endoscopy reports (attachment removed to protect patient identity), I can see ulcers in the esophagus (food pipe) over its lower end, suggesting pill-induced ulcers.
At your first endoscopy, you were taking Ecopsirin, which was responsible for the development of ulcers. Hence this medication was stopped by your physician and asked you to start Cilodoc. This is perfectly fine.
In the next endoscopy, you have shown some, however, improved ulcers in the lower part of your food pipe plus severe erythema (redness) in the stomach and duodenum (small bowel). Since you did not mention whether your gastroenterologist had taken a biopsy and checked for H.pylori infection, this bug can cause infection in the stomach and lead to redness or ulcers formation. It can even cause low iron absorption from the gut resulting in iron deficiency anemia, such as in your lab testing and repeat drop in hemoglobin.
Lastly, your colonoscopy was relatively normal, but some abnormal bunch of blood vessels called angiodysplasia are present. The one I have seen on colonoscopy picture of hepatic flexure. This abnormal blood vessel can leak blood that is not seen in stools (occult blood), resulting in anemia/low hemoglobin.
So to summarize, you had pill-induced esophageal ulcers plus redness of stomach and duodenum plus colonoscopy showing angiodysplasia. They all are the probable causes of low repeated hemoglobin.
I suggest you test.
1. Stool for H.pylori antigen.
2. Anti TTG IgA and IgG.
3. Bun creatinine lytes.
4. Stool detail report.
5. Stool for occult blood (three samples on three consecutive days).
6. Fecal calprotectin level.
7. Complete blood count.
And please follow the recommendations.
I suggest you discuss and consider stopping Zyven (Desvenlafaxine) after consulting with your psychiatrist. This medication can cause an increased risk of gastrointestinal bleeding and may be partly responsible for occult blood in stools and resulting in recurrent anemia/low hemoglobin.
Avoid using painkillers since painkillers like Ibuprofen, Diclofenac sodium, and Aspirin can all cause bleeding in the gastrointestinal tract.
Start capsule Esomeprazole 40 mg half an hour before breakfast daily unless I advise you to stop. This is acid suppressant medication. It will heal ulcers in the food pipe that you have in the past or maybe present now. It corrects redness in the stomach and is an effective drug in the management of foreseen H.pylori infection. I want you to start these medications after giving a stool sample for testing.
Follow up with me after getting your tests done. If, for example, we found active H pylori infections, I will give you an antibiotic for it.