Kenneth Neville presents interesting problems for specialists and generalists alike.1 At the time of the case presentation, we were told about a young man with distressing symptoms of postprandial vomiting leading to weight loss and weakness. The local hospital had diagnosed gastro-oesophageal reflux disease, and a battery of other routine investigations had given negative results. We were presented with several possibly relevant psychological factors, and it was mentioned that his asthma had been difficult to control. Readers were invited to consider the differential diagnosis and to suggest the most helpful course of management for the family doctor to take when …