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A 27-year-old Caucasian male presented with a one-month history of diarrhoea, severe abdominal cramping, heartburn and weight loss. The symptoms began right after breakfast in the morning and continued with 3–4 watery stools throughout the day, but none during the night. Spicy foods, alcoholic beverages and excessive water intake seemed to exacerbate the pain, but soda seemed to alleviate it. The patient denied use of antibiotics, antispasmodics, or antihypertensive drugs, and drank minimal milk. The patient denied any recent international travel or contact with diapers or ill persons but confirmed that the symptoms started about a week after a river trip. There was no known family history of GI disease. Endoscopically, the …
Contributors DJL contributed to the design of the study, drafting the manuscript, interpretation of the pathology, and final approval of the article. JJW contributed to the design of the study, drafting the manuscript, obtaining the patient's written consent, interpretation of the gastroenterology, and final approval of the article. JAN contributed to the design of the study, drafting the manuscript, administrative tasks and final approval of the article.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.