Diagnostic and treatment challenges in the centrally mediated abdominal pain syndrome – a case report.

摘要

Aim: The objective of this report is to present the diagnostic challenges in the case of a 73-years-old woman who presented for anatypical abdominal pain, experienced during the last 40 years, with very short calm periods. Case report: Between 1973 and 2016, the patienthad multiple admissions and medical consultations, different opinions about her symptoms being raised by her doctors. She had undergonetherapy with antiseptic, anti-inflammatory agents, regulators of gut motility, gastric anti-secretory drugs. The experienced response to treatmentwas always poor, no drug being found useful in those 40 years. Discussion: Due to the presence of chronic visceral pain of undetermined etiologyand in the absence of organ damage (as stated by biological, imagistic and endoscopic tests), according to Rome IV criteria we establishedthe diagnosis of centrally mediated abdominal pain syndrome. The treatment was initiated with low dosage tricyclic antidepressants, namely25 mg Amitriptyline, which led to the complete remission of the abdominal pain after about one month of treatment. Conclusion: This clinicalcase emphasizes the difficulty of implementing a clear diagnostic algorithm for the centrally mediated abdominal pain syndrome. Also, ithighlights the need to improve time management and hospitalization costs, the importance of establishing a therapeutic approach and a doctorpatientrelationship based on trust, as well as the need for a multidisciplinary team approach.