A 55-year-old female presents with chronic diarrhea and bloating. She has tried over-the-counter remedies without success. She also reports fatigue and has noticed bruising easily. What could be the potential causes and the next steps?
Chronic diarrhea and bloating can have many potential causes including irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), celiac disease, or chronic infections. However, the additional symptoms of fatigue and easy bruising raise the suspicion for malabsorption syndromes, which can also include celiac disease or conditions like pancreatic insufficiency. The next steps would include a complete blood count and blood chemistry to check for anemia and nutrient deficiencies. Testing for celiac disease (serologic tests and possibly endoscopy with biopsy) and stool tests to check for fat malabsorption could be considered.