Upper gastrointestinal (GI) complaints are common, but symptoms like heartburn, gastroesophageal reflux, non-ulcer dyspepsia, and peptic ulcer disease are often difficult to differentiate from those of the irritable bowel syndrome (abdominal pain, abdominal distention, relief of pain with defecation, frequent stools with pain onset, loose stools with pain onset, mucus passage, and the sensation of complete evacuation or tenesmus). The two groups of symptoms may indicate, respectively, dysfunction in the greater and the lesser splanchnic nerves.
           

Upper GI complaints are usually associated with mid-dorsal back pain and signs of spondylotic radiculopathy (such as tenderness and trophedema) in the mid-dorsal back (T2-5). The irritable bowel syndrome is generally associated with the lower dorsal back (T5- L1), but it is not uncommon for a patient to suffer from both groups. Dorsal spondylosis commonly remains silent until symptoms are precipitated by emotional stress or physical strain (lengthy air travel and carrying heavy baggage, for instance).

There is tendency to over-investigate these symptoms because they can suggest something benign or something serious. Since these symptoms respond quickly to the release of paraspinal muscle contractures in affected segments, however, it is feasible and probably preferable to try IMS first.