A 32-year-old woman comes to the clinic complaining of a 3-month history of abdominal bloating,…

A 32-year-old woman comes to the clinic complaining of a
3-month history of abdominal bloating, crampy abdominal pain, and a change in
her bowel habits. Previously she had regular bowel movements, but 4 months ago,
she developed gastroenteritis with nausea and vomiting after a cruise. The
constant diarrhea and vomiting went away after a week, but since then she has
had periods of constipation, lasting up to 3 days, alternating with periods of
diarrhea. During the diarrheal episodes, she can have three to four loose bowel
movements per day, though without blood or mucus in the stool. She
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A 32-year-old woman comes to the clinic complaining of a
3-month history of abdominal bloating, crampy abdominal pain, and a change in
her bowel habits. Previously she had regular bowel movements, but 4 months ago,
she developed gastroenteritis with nausea and vomiting after a cruise. The
constant diarrhea and vomiting went away after a week, but since then she has
had periods of constipation, lasting up to 3 days, alternating with periods of
diarrhea. During the diarrheal episodes, she can have three to four loose bowel
movements per day, though without blood or mucus in the stool. She describes
diffuse abdominal cramping and bloating that are somewhat relieved by bowel
movements. Her symptoms worsen during periods of stress. There has been no
weight loss or fever. There is no association with particular foods (eg, wheat
or dairy products). Her physical examination is unremarkable except for mild
abdominal tenderness with no rebound or guarding. Serologic tests for celiac
disease are negative. Stool cultures and examinations are negative for
bacterial or parasitic infections. A colonoscopy is unremarkable.

Questions

A. What is the likely diagnosis?

B. What are the theories about the pathophysiology of this
condition?

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