Gastroduodenal motility disturbances in man

The specialised regions of the stomach include the cardia, fundus, body, antrum and the pylorus. Not only do these regions have specific secretory functions, but also, they have specific motor functions as well. For example, the proximal stomach is most important in regulating emptying of liquids and the distal stomach and pylorus, the emptying of solids. Disorders of gastric emptying can be classified into two major categories: mechanical obstruction due to increased resistance and functional obstruction (gastroparesis) due to pump failure. Gastroparesis is best diagnosed using a solid test meal which is labelled by a gamma-emitting radionuclide. Agents employed to treat gastroparesis include bethanechol, metoclopramide and domperidone. Entero-gastric reflux occurs when there are abnormalities in the duodeno-gastric pressure gradient or the duodeno-gastric resistance mechanism. Excessive entero-gastric reflux may be seen in patients with gastric ulcers, chronic obstructive pulmonary disease, post-cholecystectomy syndrome or post-operative entero-gastric reflux gastritis. The diagnosis of entero-gastric reflux gastritis depends upon typical symptoms and the demonstration of excessive entero-gastric reflux by scintigraphic techniques or the measurement of bile concentrations within the stomach. Medical treatment with bile chelating agents and surface coating agents has been disappointing. Surgical treatment should only be undertaken as a last resort.