Functional abdominal pain and irritable bowel syndrome: Viva

Branch 1: History, Rome IV criteria, and distinguishing functional from organic disease

The candidate should acknowledge the parents' worry and then take a structured history rather than immediately ordering a colonoscopy. Characterise the pain by site, timing, and its relationship to defecation, and establish the stool form and frequency using the Bristol stool scale, noting that pain relieved by opening the bowels with a change in stool pattern meets the Rome IV criteria for irritable bowel syndrome. The predominant loose stools would make this the diarrhoea subtype. The key task is to screen actively for alarm features: weight loss or growth faltering, rectal bleeding, night waking, nocturnal diarrhoea, fever, joint or mouth symptoms, and the family history of inflammatory bowel disease. ^[2]

A strong candidate recognises that the relative with Crohn disease raises the pre-test probability of inflammatory bowel disease and therefore lowers the threshold for a faecal calprotectin, but that it does not by itself justify colonoscopy in a well, thriving child. Equal weight should go to the psychosocial history, especially the link with exams, and questions should be framed as routine so the family does not feel accused. If the pattern is typical, growth is normal, and no alarm features are present, the candidate should be prepared to make a positive IBS diagnosis. ^[1]