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Small intestinal bacterial overgrowth — ESEGH MCQ

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HardLuminal GISmall intestinal bacterial overgrowthESEGH

A 69-year-old man has bloating, steatorrhoea and weight loss 8 years after Billroth II surgery. He has diabetes and takes omeprazole. Blood tests show low B12 and mild hypoalbuminaemia. CT abdomen shows no mass. Symptoms improve after a course of rifaximin. What is the most likely cause?

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Correct answer: A — Small intestinal bacterial overgrowth after altered anatomy

The best answer is “Small intestinal bacterial overgrowth after altered anatomy”. Small intestinal bacterial overgrowth due to altered anatomy The alternatives “Pancreatic cancer causing biliary obstruction”, “Addison disease, within a guideline-based pathway”, “Primary lactase deficiency, after multidisciplinary assessment”, “Untreated ulcerative colitis, when clinically appropriate” are plausible in related gastroenterology presentations but do not match the defining finding, threshold, sequence or UK pathway in this stem.

Reference: British Society of Gastroenterology clinical resources: https://www.bsg.org.uk/