Diarrhea, PPI Use, and Pain in a Restaurant Worker From Mexico

Jaimy Villavicencio Kim, MD; John W. Birk, MD

Disclosures

November 18, 2022

Physical Examination and Workup

Upon examination, the patient has a temperature of 98.3 °F (36.8 °C), a blood pressure of 113/68 mm Hg, a heart rate of 72 beats/min, and a respiration rate of 18 breaths/min. His weight is 165 lb (74.8 kg), his height is 5 ft, 2 in (1.575 m), and his body mass index is 30.4. The results of the physical examination are unremarkable. He has no pallor or lower-extremity edema. His mucous membranes are moist. His abdomen is soft and nontender, with normal bowel sounds.

The laboratory workup reveals these values:

  • Immunoglobulin (Ig) A: 278 mg/dL (reference range, 47-310 mg/dL)

  • Tissue transglutaminase IgA antibody: < 1 U/mL (reference range, < 15 U/mL [antibody not detected])

  • Thyroid-stimulating hormone: 1.84 mIU/L (reference range, 0.27-4.20 mIU/L)

  • C-reactive protein: 0.36 mg/dL (reference range, 0-0.49 mg/dL)

  • Erythrocyte sedimentation rate: 12 mm/h (reference range, < 15 mm/h)

  • Stool calprotectin: 94 µg/g (reference range, > 120 µg/g)

  • Hemoglobin: 16.5 g/dL (reference range, 13-17.7 g/dL)

  • Mean corpuscular volume: 82 fL (reference range, 80-100 fL)

  • Alkaline phosphatase: 107 U/L (reference range, 45-128 U/L)

  • Aspartate aminotransferase: 47 U/L (reference range, 10-55 U/L)

  • Alanine aminotransferase: 94 U/L (reference range, 10-55 U/L)

  • Total bilirubin: < 0.2 mg/dL (reference range, 0.2-1.0 mg/dL)

  • Albumin: 4.7 g/dL (reference range, 3.5-5 g/dL)

  • Stool ova and parasites: negative, including Giardia and Cryptosporidium antigens

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