Worsening Abdominal Pain and Bloating in a 30-Year-Old Woman

Mohammad Elbatta, MD; Jason Schairer, MD

Disclosures

August 12, 2019

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 30-year-old woman presents with recurrent abdominal pain and loose stools. She states that she has experienced these symptoms since adolescence, with periods of improvement and worsening over the years. Over the past year, her symptoms have been occurring more frequently and with greater severity. For the past 6 months, she has been bothered by bloating. The bloating seems to worsen with food intake.

When questioned about abdominal pain, the patient describes it as 6 (on a scale of 10) at its worst. Acute worsening occurs immediately before defecation, with significant improvement after defecation. She has had this pain at least once every week for the past 6 months.

The patient has loose stools approximately one third of the time and often has two or three bowel movements per day (with a baseline of one bowel movement a day). She denied waking up at night to have a bowel movement and denied any blood in the stool. She has had no nausea, vomiting, or change in weight. No relationship was found between her symptoms and her diet, including milk products, spicy foods, alcohol, and processed meats. She denies excessive hunger or anorexia symptoms.

Other than her mentioned symptoms, the patient considers herself healthy. She has no chronic illnesses or prior surgeries. She has no family history of organic gastrointestinal diseases, such as inflammatory bowel disease, cancer, or celiac disease.

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