Needle in a Haystack

A 50-year-old woman reported multiple, loose bowel movements associated with mild, cramping abdominal pain. She had been well until 2 months earlier, when her bowel habits changed from one formed stool per day to frequent loose stools of moderate volume. A 50-year-old woman reported multiple, loose bowel movements associated with mild, cramping abdominal pain. Two months earlier, her bowel habits changed from one formed stool per day to frequent loose stools of moderate volume. Foreword In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage A 50-year-old woman reported multiple loose bowel movements associated with mild, cramping abdominal pain. She had been well until 2 months earlier, when her bowel habits changed from one formed stool per day to frequent loose stools of moderate volume. The abdominal pain was variable in intensity and was slightly relieved with defecation. She had no recent dietary changes and no family history of intestinal problems, and she had not traveled outside the United States. She did not have anorexia, weight loss, hematochezia, episodes of constipation or abdominal bloating, fever, dyspnea, nausea, vomiting, pruritus, or flushing. Response Diarrhea is . . .