A 45-Year-Old Man Comes to the Office Due to Several

A 45-year-old man comes to the office due to several months of diarrhea.  The patient experiences watery diarrhea shortly after eating, occasional abdominal discomfort, easy fatigability, and unintentional weight loss.  He has a history of Crohn disease for which he takes mesalamine.  The patient also takes prednisone intermittently for disease exacerbations, and 6 months ago he was treated with metronidazole for a perianal abscess.  Surgical history includes several intestinal resections due to complications of Crohn disease.  He does not use tobacco or illicit drugs but drinks alcohol occasionally.  Physical examination shows conjunctival pallor.  The abdomen is nondistended, soft, and nontender.  Vibratory and position sense are decreased in the lower extremities.  Stool guaiac test is negative.  Laboratory studies show macrocytic anemia and a low vitamin B₁₂ level.  Which of the following is the most likely cause of this patient's presenting symptoms?

A) Hormone-induced luminal secretion
B) Infection with a protozoan parasite
C) Infection with gram-positive, PAS-positive bacilli
D) Loss of intestinal absorptive area
E) Medication adverse effect
F) Pancreatic enzyme deficiency
G) Postprandial rapid fluid shifts

Correct Answer:

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