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The effect of intravenous infusion of gastrin II on gastric and colonic motor activity was studied in 12 patients; gastric acid output was also measured. Administration of gastrin at near-maximal dose levels stimulates the motor activity of the antrum but has no measurable effect on the activity of the proximal colon, sigmoid, or rectum. The results suggest that gastrin plays a part in the regulation of gastric motility but that it is not a mediator of the gastro-colic reflex.

Numerous investigators have reported a delay in gastric evacuation as a result of placing acid, fat, gastric juice, etc., in the duodenum or other parts of the small intestine. The effect has generally been attributed to a reflex (the “Hirsch v. Mering reflex”) causing tonic contraction of the pyloric sphincter. However, two studies record inhibition of contractions of the pars pylorica following the introduction of acid1 or fat2 into the duodenum. Apparently both investigations were made upon the empty stomach, though Edelmann2 observed inhibition of gastric contractions during secretion of gastric juice. There are no data in either report to prove that the phenomenon occurs in the full stomach or has any bearing on the mechanism of gastric evacuation.We studied the effect of placing various substances in the duodenum while recording graphically the tone changes in the pyloric sphincter by means of the pressure tonometer,3 and the contractions of the pars pylorica by means of a balloon placed in the pylo...

Enterogastric reflux gastritis and esophagitis is best known after gastric resections and pyloroplasty but it also occurs spontaneously in the nonoperated patient. Forty-two patients are presented who meet the criteria for the diagnosis: constant burning epigastric pain, worse after meals, unrelieved by antacids and diet; endoscopic demonstration of a gastric bile pool; endoscopic biopsy proof of gastritis and esophagitis; and hypochlorhydria. Patients with mild and moderate stages of the disease can benefit from metoclopramide therapy which improves the gastric emptying mechanism. Of the surgical patients with intractable symptoms, 90% were women, 90% had marked hypochlorhydria, 83% had biliary disease, current or remote, and 50% had anemia. With vagotomy, antrectomy, and Roux-Y anastomosis 45-60 cm downstream, the clinical response has been most encouraging.

The walls of the normal fasting stomach are maintained in coaptation by a state of tonus of its muscular coats, with recurrent periods of superimposed peristaltic activity. With the first taste of food there follows an immediate relaxation of gastric tonus with usually a fairly complete inhibition of peristalsis, resulting in a widening of the gastric lumen to accommodate the expected food injesta. This is the normal gastric feeding reflex (fig. 1). In the presence of various types of extragastric pathologic change, usually intra-abdominal or pelvic, this normal feeding reflex is distorted. Instead of relaxation there is an immediate increase in tone, with or without superimposed peristalsis. The degree of distortion roughly parallels the intensity of the sensory or psychic stimuli (fig. 2 A and B ) and is not influenced by the degree of acidity of the gastric secretions (table 1). These distortions of the normal gastric feeding reflex are