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Matt is a 20 year old engineering student. He returns to university after the
Christmas break feeling tired. Despite eating well over the holidays he notices his pants appear loose. He has been embarrassed by the increased urge to pass gas when sitting in class. (His friend Jane now sits with one seat between them.) He thinks that the fatigue he is experiencing is related to the fact that he now has to get up during the night to have a bowel movement, in addition to going at least twice during the day. He
also notices that he now gets terrible gas pains after drinking milk. He stops drinking milk for a week thinking that maybe he picked up that Norwalk virus from his roommate. This makes his gas pains somewhat less but he still is getting up to go to the bathroom at night. On a weekend phone-call to his parents, his mother tells him his 11 month old niece was just diagnosed with celiac disease. Could Matt and his niece have the same
problem?
Why did eliminating milk partially improve Matt’s symptoms?
A. Because Matt suffers from primary lactose intolerance caused by the genetically programmed, progressive loss of lactase - which often occurs in adulthood.
B. Because Matt likely has celiac disease, he is suffering from symptomatic or secondary lactose intolerance.
C. Lactase is typically produced by the brush-border cells of the intestinal mucosa, but these cells are damaged and destroyed in celiac disease.
D. Because Matt gulps his milk too quickly, the extra air he swallows produces the terrible gas pains he experiences
E. Eliminating milk only partially improved Matt’s symptoms because he has developed an allergy to milk proteins that resulted in damage to his intestinal villi, and the GI tract still needs time to repair itself
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