30th July 2023

A 40-year-old man presents to his GP with a one-month history of diarrhoea, weight loss and joint pains

A 40-year-old man presents to his GP with a one-month history of diarrhoea, weight loss and joint pains. He also reports noticing his stools having a foul smell. He is otherwise fit and well and works as a salesman. Blood tests show evidence of anaemia. After review, he is referred to a specialist for further investigations. Amongst further blood tests, he undergoes an upper GI endoscopy with biopsy, which shows the presence of Periodic-acid-Schiff positive macrophages.

Given the likely diagnosis, choose the most appropriate initial treatment from the options below.

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