In 1637 Rene Descartes wrote “The soul by which I am, what I am, is entirely distinct from my body and even if the body were not, the soul would not cease to be what it is”.1 Descartes was thus reflecting on the longstanding conundrum of relationships between body and soul which have continued to this day and are equally mirrored in our views on diseases of the gastrointestinal tract.

The fathers of gastroenterology clearly recognised the relationships between the brain and gut. In his classic studies of the control of gastric secretion conducted on his subject Tom with a permanent gastric fistula,2 Stuart Wolf found that emotional state affected secretion and that mucosal blood flow, measured by a simple thermistor, altered in parallel.3 Similar relationships between rectal mucosal blood flow and psychological state were also reported by Almy.4 In his now classic “hoax” experiment, he induced anxiety in a “volunteer” by pretending to identify an abnormality during sigmoidoscopy. This induced a marked change in colonic motor activity and a change in mucosal colour.

In the last half century however the onset of an era of objectivity has influenced how we view gastrointestinal symptoms. Quite rightly …