On page 394, Talley and colleagues report the results of a population based study which attempted to explain health care seeking for irritable bowel syndrome (IBS). Of their sample, 13% had IBS by Manning criteria and of these 73% had sought medical care for abdominal pain or discomfort. Those who had and had not sought medical care were compared—severity and duration of the abdominal pain were independently associated with health care seeking but psychological status and history of childhood abuse were not.

 This finding may be surprising as previous work in the USA had concluded that symptoms of psychological distress are unrelated to IBS but related to health care seeking1 and this view is often quoted in the literature. Talley et al’s study seems to contradict this finding. How does it compare with other research?

 Two careful studies used a diary to record bowel symptoms. Both found that abdominal pain and diarrhoea differentiated IBS consulters from non-consulters.2 ,3 In the study by Heaton et al, the likelihood of consulting a physician with …