One of the key components of healthcare utilization in the

38-year-old man without a significant medical history presents for an evaluation. He reports a 9- to 12-month history of intermittent diarrhea associated with mild cramping. He reports that his stools are usually large volume, nonbloody, and greasy. He has unintentionally lost more than 20 lb during this period but says that his appetite and oral intake have been good. He has tried taking a proton pump inhibitor daily for the last several months, but it has not improved his symptoms. He also tried refraining from any intake of dairy products, but that did not affect the diarrhea either. He has not experienced fever or any other constitutional symptoms. He does not smoke and drinks an occasional beer on the weekends, but not regularly. He is married, is monogamous, and does not know his family medical history due to being adopted. On examination, he is afebrile, normotensive, and comfortable appearing. He has some glossitis but no oral lesions. His chest is clear to auscultation, and his heart is regular in rate and rhythm. On abdominal examination, his bowel sounds are active; no tenderness, masses, or organomegaly are evident on palpation. Rectal examination is negative for occult blood. He has some patches of papulovesicular lesions on his elbows, knees, and abdomen with some excoriations; he says it is very itchy. Questions

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