Review Question - QID 210703

A 42-year-old man presents to the gastroenterologist for chronic diarrhea and weight loss. He reports that the diarrhea began 3 months ago. He denies seeing blood in his stool but states that his stool is foul-smelling and often “floats in the bowl.” He reports that since his symptoms began he “can’t wear pants without belts.” He has not weighed himself recently. His normal diet consists of mainly red meats, cheese, fast food, and sugary, carbonated drinks. The patient recently immigrated from Barbados 1 year ago but has not been back since. His medical history includes arthritis and hypothyroidism. He takes aspirin and levothyroxine. The patient’s temperature is 100.9°F (38.3°C), blood pressure is 130/78 mmHg, pulse is 82/min, and respirations are 14/min. Physical examination reveals skin hyperpigmentation and swollen, painful elbows and knees. A fecal occult blood is positive. A colonoscopy is done with a biopsy and Periodic acid-Schiff staining, as shown in Figure A. Which of the following is the most appropriate long-term therapy for the patient’s most likely diagnosis?