She tells you that she had similar problems around the age of 17 years which led to time off school. She thinks that her pains are made worse after eating citrus fruits and after some vegetables and wheat. Currently, she is working as a secretary.
She has tried to exclude these from her diet with some temporary relief but overall there has been no change in the symptoms over the 6 years. Opening her bowels tends to relieve the pain which has been present in both iliac fossae at different times.
On asking about any previous surgeries, her husband replies that she had one a year ago she had a sigmoidoscopy at a gastroenterology clinic which was normal. She found the procedure very uncomfortable and developed similar symptoms of abdominal pain during the procedure. She is anxious about the continuing pain but is not keen to have a further endoscopy.
She has a history of occasional episodes of headache which have been diagnosed as migraine and has irregular periods with troublesome period pains but no other relevant medical history. She is a non-smoker who does not drink alcohol.
She also reveals that her parents are alive and well but her paternal grandmother died of carcinoma of the colon at 64 years.
Perfecto!! Now that you have taken the complete history what should be your next step?