Case Report: Breaking the cycle: preventing diagnostic escalation in pediatric chronic functional abdominal pain

Chronic abdominal pain in children often stems from disorders of gut-brain interaction (DGBI), yet families may struggle to accept these diagnoses when tests are normal. This case describes an eleven-year-old boy with persistent epigastric pain after abdominal injury whose presentation was most consistent with functional abdominal pain-not otherwise specified (FAP-NOS) under the Rome IV criteria. Despite extensive negative evaluations, his family believed vascular pathology was responsible, leading to escalating interventions including celiac plexus block and median arcuate ligament release. Symptoms returned post-operatively, consistent with gut-brain interaction rather than structural disease. This case underscores the critical need for early, clear explanations of gut-brain mechanisms that validate symptoms and address caregiver concerns, preventing diagnostic escalation and iatrogenic harm while supporting functional recovery.