All these years, I have been teaching that "chronic" pain in the epigastrium, is usually due to peptic ulcer (or non-ulcer dyspepsia), gall bladder or pancreatic causes. Over the years I have seen hundreds of cases where the doctors have been misguided and have been treating patient as a case of peptic ulcer or non-ulcer dyspepsia because the sonography has excluded gallbladder and pancreatic causes. But the patients are not relieved-why?

Though, it is a fact that many of the above patients have some degree of associated hyperacidity, reflux oesophagitis or non-ulcer dyspepsia, their symptoms are due to irritable bowel syndrome, which has been missed just because the history taking has been inadequate.

Though we do not have very effective drugs to relieve the symptoms of irritable bowel syndrome, the patient feels happy once he knows that you have localised his complaints to a bad irritable colon.

Next time when you see a patient of reflux oesophagitis or non-ulcer dyspepsia, ask him if his pain is not a pain, but distension, heaviness, discomfort or gripe-like sensation. Often after a meal, due to gastro-colic reflex, they either like to pass stool (with or without mucus) or flatus and feel better.

For management of these patients, a full detailed discussion of their diet may point at some food item as the culprit, avoiding which will help them.

The diagnosis of all the patients discussed in this article is not facilitated by any investigation including gastroscopy or sigmoidoscopy, but will depend on how much time you have spent talking to the patient.