A 42-Year-Old Woman Comes to the Office Due to Episodic

A 42-year-old woman comes to the office due to episodic diarrhea over the past several months.  The patient describes large-volume, watery diarrhea accompanied by flatulence, typically a few hours after a meal.  She has had no fever, abdominal pain, blood in stools, or nocturnal diarrhea.  The patient has a history of Hashimoto thyroiditis and takes levothyroxine.  She drinks a glass of wine every evening with dinner but does not use tobacco or illicit drugs.  The patient says she tries to eat a healthy diet despite a busy work schedule, frequently consuming fruits, vegetables, fish, and low-fat dairy products.  Vital signs are within normal limits.  The abdomen is soft, nondistended, and nontender with no hepatosplenomegaly.  Bowel sounds are normal.  The remainder of the examination shows no abnormalities.  Stool testing for occult blood is negative, and blood cell counts, serum electrolytes, and TSH levels are within normal limits.  Which of the following is the most appropriate response to the patient regarding her symptoms?

A) Your symptoms are likely due to an autoantibody directed against a protein in your diet and can be diagnosed with antibody testing.
B) Your symptoms are likely due to changes in how food moves through the gastrointestinal tract; the cause is uncertain.
C) Your symptoms are likely due to inflammation in the gastrointestinal tract; treatment involves anti-inflammatory drugs.
D) Your symptoms are likely due to lack of a digestive enzyme and should improve with changes in your diet.
E) Your symptoms are likely due to organ damage from alcohol use and may improve with a digestive enzyme supplement.