Paediatricsmiddle twist
A 9-year-old girl has had five months of intermittent central abdominal pain, worst on school mornings. Her parents separated six months ago and she has missed ten days of school this term. Her weight has fallen from the 50th to the 10th centile; her height remains on the 50th. She passes two or three bulky, pale stools daily but no blood, and has had no mouth ulcers or perianal problems. Her mother has type 1 diabetes. Haemoglobin is 98 g/L (115-145), mean cell volume 71 fL (77-95), C-reactive protein 2 mg/L (less than 5). Which one of the following best explains both her pain and her falling weight?