• colorectal cancer
• diagnosis
• dyspepsia
• functional bowel disorders
• organic disease

Patients and clinicians are becoming increasingly intolerant of diagnostic uncertainty. This is reflected in the rising demand for endoscopic procedures¹ implicitly suggesting that gastrointestinal symptoms are an unreliable indicator of serious pathology. Unfortunately, the growing array of tests that are being demanded for patients are placing further pressures on already stretched health care budgets. The natural reaction to this is to evaluate whether we can improve on the value of the history to diagnose gastrointestinal disease. This process was started over 30 years ago when researchers such as Card and colleagues^2,3 and de Dombal and colleagues^4,5 evaluated the use of computers to aid the clinician in making diagnoses in patients with upper gastrointestinal symptoms. The enthusiasm for this approach faded when data suggested that computer improved diagnostic accuracy of computers was not sufficient to prevent investigations.⁶ The paucity of subsequent research in this field is disappointing as it would be useful to know what information computers were using that enhanced diagnostic acumen. The article by Hammer and colleagues⁷ in this issue of Gut[see page 666] is therefore refreshing as it prospectively evaluates a wide range of gastrointestinal symptoms to establish which are useful in distinguishing organic from functional disease. The strength of this study is that it evaluates a large relatively unselected group of patients, reducing spectrum and selection bias.⁸ It also divided patients into those with and without organic disease rather than subdividing the data into different diagnoses. This improves the power of the study and gives the clinician overall information on whether the …