1.6.1 Recurrent gastrointestinal disturbance

The patient is a nine-year-old schoolgirl. Over the past year she has had five separate episodes of tummy trouble, each lasting a few hours, with a queasy, unsettled feeling deep in her belly that she describes as an ache rather than a sharp pain. A dull headache comes on during most of these spells and fades once the stomach discomfort passes. Between episodes she is entirely well, eating and growing normally, with no diarrhoea and nothing else that would point to another illness. Examination each time has been normal, her tummy soft and non-tender, and no other condition has turned up to explain the pattern. She has not noticed any clear food trigger, and the spells seem to come without warning.