SIBO Causing Refractory Steatorrhoea — SCE Palliative Medicine MCQ

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HardGI SymptomsSIBO Causing Refractory SteatorrhoeaSCE Palliative Medicine

A 68-year-old man with advanced pancreatic cancer develops severe steatorrhoea despite adequate pancreatic enzyme replacement therapy (PERT) dosing, concurrent proton pump inhibitor, and correct enzyme timing with meals. What additional investigation may identify a treatable cause?

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Correct answer: D — Glucose hydrogen breath test to assess for small bowel bacterial overgrowth (SIBO) which may coexist with pancreatic insufficiency and impair fat absorption independently

Explanation lettering: C = shown as A · E = shown as B · D = shown as C · B = shown as D · A = shown as E

Option B is correct. In a patient with pancreatic cancer and refractory steatorrhoea despite optimized PERT, a superimposed cause should be sought. UK consensus guidelines for pancreatic exocrine insufficiency advise investigating persistent symptoms with additional causes such as small bowel bacterial overgrowth (SBBO) using a glucose hydrogen breath test ([bmjopengastro.bmj.com](https://bmjopengastro.bmj.com/content/8/1/e000643?utm_source=openai)). BSG cancer–treatment guidance further recommends breath testing rather than empirical antibiotics to establish SIBO in this population ([gut.bmj.com](https://gut.bmj.com/content/74/7/1040?utm_source=openai)). Option A merely re-confirms fat malabsorption without identifying treatable pathology. Option C is inappropriate in this elderly cancer patient. Options D and E address alternative pathologies unlikely to explain persistent steatorrhoea in context.

Reference: Consensus for the management of pancreatic exocrine insufficiency: UK practical guidelines, BMJ Open Gastroenterology, 2022; and BSG guidance on GI symptoms in cancer management, Gut, 2025.