Response

I applaud the concept of this type of article, which, in my experience, has been pioneered by our neurological colleagues in helping those less experienced in this discipline to tease out organic disease. I accept they are difficult articles to write, as every experienced clinician has their own way of doing things.

In the article by Valori,I am assuming that the article is indeed focusing on a voyage around the irritable bowel syndrome (IBS) in its various guises. Those phenotypes of which, I recognise and deliberately categorise (which in itself helps the patient from the outset), are:

• ■ Diarrhoeal

• ■ Constipating

• ■ Alternating

• ■ Pure recurrent abdominal pain

I respond to the current article because it addresses one of the more challenging aspects of a time-constrained gastroenterological consultation from a perspective assuming that there is indeed nothing wrong. This is a far cry from ‘unexplained’ abdominal symptoms. Irritable bowel is a disease in its own right affording respect, and, of course, we should not need reminding that even the hysteric will inevitably develop organic disease.

Winning the patient's confidence is fundamental; you are the expert in conventional medical gastroenterology. My experiences with the initial, pivotal, luxurious 20-minute consultation are that a focused approach …