Case presentationDr. Picarelli: A 41-year-old woman, presenting with along history of severe recurrent abdominal pain, wasadmitted to our gastroenterology department.The pain was intermittent during the prior 4 yearsoccurring at no set time of day or night. The abdominalpain was related neither to food ingestion, bowel move-ment, nor to flatus or stool evacuation. Exercise andemotional stress frequently caused worsening of thesymptoms. In the previous year, she reported at least fourepisodes of admission to the emergency department (ED)because of severe abdominal pain partially resolving withantispastic therapy.The patient observed weight loss since the pain moti-vated a reduced intake of food. As the pain occurred afterstress, a psychotherapy was started, but provided no benefit.Anamnestic data did not show any family history ofinflammatory bowel disease, or cancer. The patient hadundergone a cesarean section, and as well had an appen-dectomy when she was age 12.Abdominal examination disclosed distension andbloating without peritoneal signs, and negative results ofinflammatory tests. Occult fecal blood test was negative aswell as small bowel X-ray examination.Differential diagnosisDr. Paris, Dr. Di Tola, Dr. Libanori, Dr. Donato: At thefirst clinical observation, the patient presented asymptom-atic with a soft and non-tender abdomen, without detect-able masses. The abdomen auscultation disclosed only aloud systolic bruit in the epigastrium with loss of intensityduring deep inspiration.The patient was tested for lactase deficit by a lactosebreath test. A patch test for nickel was negative. Celiacdisease was excluded by endomysial and transglutaminaseantibodies sera detection. The patient also had a gastros-copy and a colonoscopy that did not show any peptic,inflammatory lesions or tumor.Preliminary diagnosisDr. Picarelli: Recurrent chronic abdominal pain is fre-quently present in many gastrointestinal diseases. Never-theless the patient presented no observable structural orbiochemical alterations. The patient was therefore consid-ered to be affected by functional disorders. The diagnosisof irritable bowel syndrome (IBS) or functional dyspepsiawas considered, and dietary and pharmacological proce-dures were undertaken. Proton pump inhibitors, antispasticand antidepressive therapies were administered, but thesymptoms did not improve. The patient continued topresent abdominal pain with nocturnal weakness.