Episode two of the Gastric and Small Bowel Motility chapter covers the episodic and functional presentations where the structural workup comes back clean and the pattern carries the diagnosis: cyclic vomiting syndrome, cannabinoid hyperemesis, chronic intestinal pseudo-obstruction, and functional dyspepsia. Reading dilated bowel or delayed emptying as mechanical disease misleads you every time. Each condition is answered by naming the pattern, not by another motility drug. Topics covered Cyclic vomiting syndrome and migraine biology Cannabinoid hyperemesis and hot-water bathing Rumination and chronic nausea/vomiting syndrome Acute colonic pseudo-obstruction (Ogilvie) Chronic intestinal pseudo-obstruction Neuropathic vs myopathic manometry Paraneoplastic pseudo-obstruction (anti-Hu, SCLC) Functional dyspepsia subtypes and alarm features Key decisions Stereotyped four-phase episodic vomiting with well intervals and migraine history: bedtime low-dose tricyclic to prevent, triptan to abort. Same cycle with daily cannabis and compulsive hot-water bathing: stop cannabis; capsaicin, haloperidol, benzodiazepine for active episodes, not a tricyclic. Chronic pseudo-obstruction manometry: neuropathic shows normal-strength disorganized contractions; myopathic shows low-amplitude contractions with pattern preserved; late scleroderma and amyloid read myopathic. Older smoker with rapidly progressive dysmotility and weight loss out of proportion: chest CT and oncologic workup for anti-Hu paraneoplastic small cell lung cancer, PET if chest CT unrevealing. Functional dyspepsia under sixty with no alarm features: H. pylori test-and-treat then empiric acid trial; sixty or older or any alarm feature, scope first. Normal emptying with impaired accommodation and fullness-type dyspepsia: buspirone; thin patient with early satiety and weight loss: mirtazapine. For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com. Questions or feedback: [email protected]. (00:00) - Introduction: the clean structural workup (00:32) - Cyclic vomiting syndrome: stereotyped four-phase attacks (01:50) - CVS treatment: prevent and abort (02:22) - Cannabinoid hyperemesis: the cannabis look-alike (04:36) - Pseudo-obstruction: dilated bowel, no transition point (05:21) - Chronic intestinal pseudo-obstruction and secondary causes (07:25) - Paraneoplastic pseudo-obstruction: the older smoker (10:42) - Functional dyspepsia: subtypes and alarm features

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“What did the council decide on item 42?” — answered with the speaker and the moment.

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