22nd July 2023

A 62-year-old woman is referred to her local gastroenterology team with a 1-year history of intermittent generalised abdominal discomfort

A 62-year-old woman is referred to her local gastroenterology team with a 1-year history of intermittent generalised abdominal discomfort. It used to only happen once a month but now occurs most days and is particularly bad after eating. The pain usually resolves spontaneously after a few hours, however, she now skips her lunchtime meal to try and reduce its frequency. As a result, she has lost 15kg and reports feeling weak. She denies PR bleeding, anorexia, change in bowel habit, reflux sensations, nausea, vomiting, fever or lower urinary tract symptoms. She has a history of rheumatoid arthritis, for which she takes methotrexate 7.5mg once a week. She is a non-smoker and drinks 10 units of alcohol a week. On examination, her abdomen is soft and non tender with active bowel sounds. Her observations are all within normal ranges. Blood tests reveal normal full blood count and liver function; however, she is deficient of calcium, magnesium and potassium. Helicobacter pylori stool antigen testing is negative.

What is the most likely diagnosis?

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