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Small Bowel· Chapter 08

Gastric and Small Bowel Motility

Gastroparesis in the GLP-1 era, the 4-hour gastric emptying scintigraphy, and what to do when symptoms don't track with delayed emptying. Cyclic vomiting and cannabinoid hyperemesis, chronic intestinal pseudo-obstruction, Ogilvie syndrome with neostigmine, and functional dyspepsia, each anchored to a testable management decision.

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30 MCQs2 podcast episodes
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What this chapter covers

  • Section 8.1: Gastric motor physiology and gastroparesis pathogenesis

    Gastric emptying is a coordinated act between three systems, and gastroparesis is what happens when any one of them fails.

  • Section 8.2: Gastroparesis diagnosis

    Gastroparesis cannot be diagnosed on symptoms alone because the symptoms (nausea, vomiting, early satiety, postprandial fullness, bloating, upper abdominal pain) overlap with functional dyspepsia, peptic ulcer disease, gastric outlet obstruction, cyclic vomiting syndrome, rumination, eating disorders, and chronic cannabinoid use.

  • Section 8.3: Gastroparesis treatment

    Gastroparesis treatment is a stepladder, and the first rungs are the most powerful.

  • Section 8.4: Cyclic vomiting syndrome and CHS

    Cyclic vomiting syndrome and cannabinoid hyperemesis syndrome share a striking clinical pattern of stereotyped vomiting episodes separated by symptom-free intervals, but they diverge on cause, on family history, and on treatment, and the boards split the two with a small number of high-yield clues.

  • Section 8.5: Small bowel motility and pseudo-obstruction

    Pseudo-obstruction is the syndrome of impaired propulsive motility that mimics mechanical obstruction without an occluding lesion.

  • Section 8.6: Functional dyspepsia

    Functional dyspepsia is the most common upper GI complaint in primary care and gastroenterology clinics, with a worldwide prevalence of 5 to 11 percent and up to 40 percent of affected patients seeking medical care.

Podcast episodes

  1. 01

    Gastroparesis

    This episode covers gastroparesis from mechanism through treatment, and the whole disease sits on one idea: emptying the stomach takes three systems working together, and gastroparesis is what happens when any one of them fails.

  2. 02

    CVS Pseudo FD

    This episode covers the episodic and functional presentations: cyclic vomiting syndrome, cannabinoid hyperemesis, intestinal pseudo- obstruction, and functional dyspepsia.