The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
An 18-year-old woman presents with 4 weeks of abdominal pain and bloating, excessive flatulence, and a 5-lb weight loss. The pain is worse after meals and is typically localized to the epigastric area. The patient has not noted any particular triggering foods; however, she has been avoiding greasy foods and dairy products. She reduced her food intake overall because of the discomfort she experiences after meals and has reported feeling slightly lightheaded at times. She denies diarrhea, vomiting, or bloody or dark-colored stools. She also denies any sick exposures or recent travel.
Her medical history is remarkable for iron deficiency anemia, asthma, and generalized anxiety, which are managed with iron supplementation, albuterol, and escitalopram, respectively. She has no known allergies and does not have any significant surgical history.
Her family history is notable for gluten intolerance in her mother, gastric cancer in a maternal uncle, and Crohn disease in a paternal uncle. She does not use tobacco products, alcohol, or illicit drugs. Recently, she started her first year of college and is living in a dormitory.
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Cite this: Flatulence and Pain in an Anxious 18-Year-Old College Student - Medscape - Feb 13, 2023.