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Functional abdominal pain — DCH MCQ

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HardBehavioural and emotionalFunctional abdominal painDCH

A 9-year-old girl has experienced poorly localised periumbilical abdominal pain on at least 4 days each month for 3 months. It usually occurs before school and is absent during school holidays. There is no nocturnal pain, altered stool frequency or form, relationship to defecation, epigastric discomfort, vomiting, pallor, headache or gastrointestinal bleeding. Her growth remains on its previous centiles and examination is normal. FBC, CRP, coeliac serology and urinalysis are normal. When seen alone, she discloses persistent cyberbullying by classmates. What is the most likely diagnosis?

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Correct answer: E — Functional abdominal pain–not otherwise specified

The diagnosis is functional abdominal pain–not otherwise specified. She has recurrent pain without red flags, impaired growth, examination abnormalities or evidence of inflammation, and the strong school-term pattern identifies cyberbullying and associated anxiety as relevant biopsychosocial triggers. The pain is real and should be positively explained rather than dismissed. Irritable bowel syndrome requires an association with defecation or altered stool frequency or form. Abdominal migraine causes stereotyped, incapacitating episodes, usually with symptom-free intervals and features such as pallor, nausea, vomiting, headache or photophobia. Functional dyspepsia is characterised by epigastric pain or burning, early satiety or postprandial fullness. Crohn disease is unlikely without diarrhoea, bleeding, weight loss, faltering growth, inflammatory features or raised CRP. Management must also include sensitive assessment and action regarding the disclosed bullying.

Reference: Hyams JS et al. Functional Disorders: Children and Adolescents (Rome IV classification), 2016. https://learning.rcpch.ac.uk/uncategorised/work-in-progress-how-to-manage-gastroenterology/