“Thank you for ending 40 years of misery”

Mary, who is 85, has been my patient for about six years. In 1957 she had had a gastroenterostomy and vagotomy for a peptic ulcer. Shortly afterwards, she had developed diarrhoea, which became chronic—she had been referred to many clinics and had been extensively investigated. No formal diagnosis seemed to have been made although malabsorption, bile acid reflux, postvagotomy diarrhoea, and dumping syndrome had been considered at one time or another.

She had trials of a fat free diet, pancreatic supplements, antibiotics, codeine, and bulking agents, but her bowels never improved. She was told that diarrhoea was something …