The skilful analysis of symptoms indicating disorders of the digestive system is an integral part of the practice of internal medicine. Many patients with abdominal symptoms do not have easily defined organic conditions. The traditional skills of taking a careful history and examining the patient thoroughly are invaluable in managing patients who have functional disorders such as ‘irritable bowel’, nonulcer dyspepsia, nonspecific diarrhoea, recurrent abdominal pain, and somatization disorder. The enormous advances in endoscopy, scanning, and other investigative techniques have not made clinical diagnosis less important. Most gastrointestinal disorders are minor self-limited conditions of uncertain cause or are functional in nature, thereby often eluding definition even if extensive diagnostic procedures are (unnecessarily) employed. At the other extreme, the early suspicion of life-threatening disease and prompt referral of patients for investigation depends on clinical judgement.