Q. A 38-year-old woman presents to the physician's clinic with a 6-month history of intermittent diarrhea, bloating, and abdominal discomfort. She reports that these symptoms seem to be more prominent after meals but cannot identify any specific food triggers. She also reports occasional fatigue and a foggy mind. She has no significant past medical history and takes no regular medications. On physical examination, her BMI is 23.2 kg/m2, within the normal range. The rest of the examination is unremarkable, with no signs of malnutrition, and the abdominal examination shows no tenderness, organomegaly, or masses. Her complete blood count reveals a hemoglobin of 14 g/dL, a white blood cell count of 7.1 x 10^3/uL, and a platelet count of 230 x 10^3/uL. A comprehensive metabolic panel, including liver and kidney function tests, is within normal limits. Thyroid function tests show a TSH of 2.1 mIU/L and free T4 of 1.2 ng/dL, within normal limits. Her CRP is 1.2 mg/L, and her ESR is 10 mm/hr, within the normal range. Serological tests for celiac disease are negative, including tissue transglutaminase IgA (0.7 U/mL) and endomysial antibody IgA. What would be the most appropriate next step in management?

Log In or Start Your Free Trial
to view the answer.