Picture the scene. An international conference on gastroenterology, delegates flown in from the four corners of the earth, a nice hotel near the sea and golf courses, and one of those keypad voting systems. Dyspepsia? Easy! Dish out a PPI and lets get on to the really interesting stuff like fucosyltransferases and Ki-ras gene point mutations.

But wait! The audience has been asked what it would do with a 43 year old man with an 18 month history of vague upper abdominal pain, a stressful …