20th July 2023

A 42-year-old man presents to his GP with a 4-month history of continuous mild nausea

A 42-year-old man presents to his GP with a 4-month history of continuous mild nausea, abdominal bloating and constipation. He has a past medical history of systemic sclerosis, hyperthyroidism and chronic right knee pain. He takes nifedipine 10 mg three times daily (TDS), carbimazole 30mg once daily (OD) and paracetamol 1g four times daily (QDS) as required (PRN). He is allergic to penicillins. He is an ex-smoker (10-pack year history), drinks 4 units of alcohol a week and works as an accountant. Clinical examination reveals tight skin over his hands but is otherwise unremarkable. His blood tests reveal a raised folate level but are otherwise normal. He undergoes further testing which confirms a diagnosis of SIBO.

Which of the following from this patient’s history is a risk factor for this condition?

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