A 14-year-old girl has experienced vomiting, abdominal pain, and weight loss over the past 11 months. The symptoms initially were associated with consumption of dairy products, and a switch to soy-based products led to temporary improvement. However, she continues to have nonbloody, nonbilious vomiting. She has restricted her intake for fear of vomiting. Four months earlier, an evaluation that included abdominal and pelvic ultrasonography and head CT scan was performed by a gastroenterologist and yielded normal results. Trials of prochlorperazine, metoclopramide, and proton pump inhibitor were unsuccessful. She denies diarrhea, headache, fevers, chills, dysuria, dysmenorrhea, binging, purging, and dieting as well as the use of laxatives, diuretics, tobacco, alcohol, or drugs. She reports regular menstrual periods monthly. Past medical history is significant for two episodes of urinary tract infections. Family history is noncontributory. She lives with her parents and siblings. She is in the ninth grade, has a grade point...

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