A patient presents with lower gastrointestinal bleed. Sigmoidoscopy shows ulcers in the sigmoid. Biopsy from this area shows flask-shaped ulcers. Which of the following is the most appropriate treatment ?
**Core Concept**
The patient's presentation of lower gastrointestinal bleed with flask-shaped ulcers on sigmoidoscopy and biopsy is suggestive of amoebic colitis, a condition caused by the protozoan parasite Entamoeba histolytica. The flask-shaped ulcers are a characteristic feature of amoebic colitis.
**Why the Correct Answer is Right**
Amoebic colitis is caused by the invasion of Entamoeba histolytica into the intestinal mucosa, leading to ulceration and bleeding. The flask-shaped ulcers are a result of the amoeba's ability to penetrate the mucosa and create a cavity. The treatment of choice for amoebic colitis is metronidazole, an antibiotic that is effective against anaerobic bacteria and protozoa, including Entamoeba histolytica.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because ciprofloxacin is a broad-spectrum antibiotic that is effective against a wide range of bacterial infections, but it is not the first-line treatment for amoebic colitis.
**Option B:** This option is incorrect because omeprazole is a proton pump inhibitor that is used to reduce stomach acid, but it is not effective against amoebic colitis.
**Option C:** This option is incorrect because sulfasalazine is a medication used to treat inflammatory bowel disease, but it is not effective against amoebic colitis.
**Clinical Pearl / High-Yield Fact**
Amoebic colitis can mimic other conditions such as Crohn's disease or ulcerative colitis, making it essential to perform a stool examination for ova and parasites to confirm the diagnosis.
**Correct Answer:** C. Metronidazole.