You are in a GP surgery.
A 48 year old lady presents with a 12 month history of vague abdominal symptoms including bloating, increased amounts of flatus, intermittent loose stools, vague abdominal cramping pains. Symptoms seem to be worse in the first few hours after eating.
Her trousers have become very tight.

She also notes feeling lethargic. She is a keen amateur athlete and normally goes to the gym several times a week, as well as running and cycling several times a week. However, she has been unable to do her usual exercise routine as she has felt too tired.

She also notes that she has put on about 2-3 kgs of weight unintentionally in the last 3-6 months. She puts this down to exercising less often because she doesn’t feel up to it.

Her periods have not changed. They have always been light and remain the same now.
She has no previous significant abdominal or gynaecological history, except that she has two healthy teenage children.

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What is the most likely differential diagnosis?

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