A 38-Year-Old Man Comes to the Office with Abdominal Discomfort

A 38-year-old man comes to the office with abdominal discomfort and loose stools over the past year.  He has also lost 10 kg (22 lb) despite having a normal appetite.  The patient eats a balanced diet that includes a variety of fruits and vegetables, meats, whole grains, and dairy products.  He has had no international travel, works indoors as an office manager, and has no sick contacts.  Medical history is insignificant and the patient takes no medications.  The patient drinks alcohol socially and does not use tobacco.  Vital signs and physical examination are normal.  Serum chemistry panel, complete blood count, and thyroid function tests are normal.  Which of the following is the best next step for assessing for impaired nutrient absorption in this patient?

A) Abdominal ultrasound
B) Colonoscopy
C) Jejunal biopsy
D) Stool evaluation for ova and parasites
E) Stool microscopy with Sudan III stain
F) Vitamin B ₁₂ level

Correct Answer:

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