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Irritable bowel syndrome, dyspepsia and other chronic disorders of gastrointestinal function

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New diagnostic criteria and knowledge are changing how patients are treated

In this issue of the MJA, we highlight a number of topics of major interest in gastroenterology, including Barrett’s oesophagus,1 the risks of proton pump inhibitors,2 biosimilars for inflammatory bowel disease,3 and gluten intolerance.4

Chronic or recurrent gastrointestinal symptoms are frequently encountered in primary care.5 Most patients who present with gastrointestinal symptoms do not, however, have inflammatory bowel disease, cancer or another sinister pathology, but rather an unexplained or functional gastrointestinal disorder (FGID).6 The best known FGID is the irritable bowel syndrome (IBS), but there are other FGIDs that need to be recognised, as there is effective management that can improve people’s lives.69 The expert consensus is that clinicians should strive to make a positive clinical diagnosis of an FGID on the basis of the patient’s history, and not simply wait for negative test results.6 In 2016, new international guidelines on diagnosis were published, the updated Rome (IV) Criteria (