Functional abdominal pain and irritable bowel syndrome: Case

This girl shows the Rome IV picture of irritable bowel syndrome: recurrent lower abdominal pain eased by defecation, alternating loose and hard stools, bloating, and urgency, in a well child with steady growth and a normal examination. The mixed stool pattern places her in the IBS-M subtype, and the onset after gastroenteritis fits a post-infectious IBS. Her anxiety, the school avoidance, and the parental worry are the psychosocial drivers that management must address. ^[1]

Clinical findings

The pattern is strongly functional. Pain relieved by opening the bowels with a change in stool form meets the Rome IV criteria for irritable bowel syndrome, and the normal growth and examination make significant organic disease unlikely. The onset after a bout of gastroenteritis supports a post-infectious mechanism, in which transient gut inflammation sensitises the gut-brain axis. The differential still includes coeliac disease and, given the diarrhoeal component, inflammatory bowel disease, which the workup should exclude before the diagnosis is settled. ^[2]