Answer: B. The most likely cause for the patient’s odorous stools is small bowel bacterial overgrowth. Small bowel bacterial overgrowth is caused by excess non-native or native bacteria in the small intestine. Those with small bowel bacterial overgrowth may be asymptomatic or may have one or more symptoms, including bloating, abdominal discomfort, diarrhea, dyspepsia, and in some cases weight loss. Those at greatest risk for small bowel bacterial overgrowth include those with motility disorders, liver cirrhosis, chronic pancreatitis, or anatomic abnormalities such as Roux-en-Y gastric bypass. Because of this patient’s history of Roux-en-Y gastric bypass surgery and her long history of odorous frequent stools, small bowel bacterial overgrowth should be suspected.

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