22nd July 2023

A 23-year-old man presents to a gastroenterology outpatient clinic with a 9-month history of difficulty opening his bowels

A 23-year-old man presents to a gastroenterology outpatient clinic with a 9-month history of difficulty opening his bowels and generalised abdominal discomfort, which has worsened over the last 4 weeks. He now opens his bowels approximately twice a week, compared to once a day previously. His abdominal pain settles once he passes stool, however, he has noticed his stool is hard and “pellet-like”. He denies a change in appetite, weight loss, nausea, vomiting, haematemesis, PR bleeding or melaena. He is otherwise well with no past medical history and no significant family history of GI disease. He is currently unemployed, having lost his job in a bar 10 weeks ago, and since then he has not been sleeping well. On examination, his abdomen is soft and non-distended with normal bowel sounds. A PR exam reveals no masses or evidence of PR bleeding.

Which of the following tests should form part of the initial work up for this man’s symptoms?

Select the SINGLE most appropriate option from the list below. Select ONE option only.