DDSEP® 8 Quick Quiz

Question 2

A 66-year-old woman with a history of atrophic gastritis presents for evaluation of intermittent diarrhea. She denies abdominal pain, weight loss, GI bleeding or a family history of colorectal neoplasia or IBD. Physical exam is normal. Labs including thyroid function testing, celiac screen and CRP are normal. A colonoscopy with random colon biopsies is normal.

What is the best next step in the management of this patient?

Measure chromogranin A

Start eluxadoline

Video capsule endoscopy

Glucose hydrogen breath test

Q2. Correct answer: D. Glucose hydrogen breath test.

The etiology of small intestinal bacterial overgrowth (SIBO) is complex but may include an issue with altered antibacterial defense mechanisms, such as achlorhydria from atrophic gastritis. SIBO can be diagnosed by a glucose hydrogen breath test, and therefore, it is the best next step in the management of this patient's symptoms given the history of atrophic gastritis. Chromogranin A testing and video capsule endoscopy are used in the diagnostic evaluation of suspected carcinoid syndrome and inflammatory bowel disease, respectively, and may be indicated in the subsequent evaluation of this patient's symptoms. In addition, both of these diagnoses are unlikely to cause intermittent diarrhea. Eluxadoline is an agent that combines a mu-opioid receptor agonist and a delta-opioid receptor antagonist and is indicated for the treatment of irritable bowel syndrome - diarrhea predominant (IBS-D). The diagnosis of IBS requires the presence of abdominal pain and is unlikely in an elderly patient with new onset of symptoms; therefore, this is not the diagnosis in this patient's case.

Jan Bures et al. World J Gastroenterol. 2010 Jun 28;16(24):2978-90.

Next Article: