Card 17 / 33: The following case presentation is for questions 15 and 16: A 55 year old woman with scleroderma has, in addition to complaints of dysphagia to solids and liquids, a one year history of non-bloody diarrhea. She has additional symptoms of abdominal gas and bloating. She has lost approximately 10 lbs. In evaluating her dysphagia an upper gastrointestinal series with barium is performed and the radiologist gives more barium to allow examination of the small intestine. The small intestinal portion of the test is remarkable for several small bowel diverticula. You suspect her diarrheal symptoms are due to small intestinal bacterial overgrowth syndrome. What is the most likely pathophysiologic mechanism that explains why vitamin D is malabsorbed in this patient?This patient has an abnormal bone density study. A vitamin D level is checked and it is low.
A) Excess bacteria cause rapid intestinal motility
B) Bile acids are not appropriately reabsorbed
C) Excess bacteria cause mucosal damage
D) Pancreatic enzymes are inactive in the presence of excess bacteria
E) Bile acids are decongugated in the intestinal lumen

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