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A dual isotope radionuclide technique has been used to assess solid and liquid gastric emptying simultaneously in 72 patients with symptomatic gastro-oesophageal reflux and 22 normal controls. Objective evidence of gastro-oesophageal reflux was obtained from standard acid reflux testing and/or endoscopy in all patients. Solid emptying was delayed in 32 patients (44 per cent), liquid emptying was delayed in 27 patients (37 per cent) and 16 of those two groups had delayed solid and liquid emptying. Thus 29 patients (40 per cent) had normal solid and liquid group (P less than 0.01). There was a significant correlation (P less than 0.01) between the solid and liquid gastric emptying values obtained in patients. No significant correlation was found between gastric emptying and the resting lower oesophageal sphincter pressure or the presence of symptoms of regurgitation and epigastric fullness. In the patients with delayed solid emptying there was a higher incidence of oesophagitis than in patients with normal emptying (P less than 0.05).

In 178 consecutive oesophageal squamous carcinoma cases, 5% (9 cases) had had thyrotoxicosis, hypothyroidism or thyroid carcinoma. The incidence in males was 1% (1 case) and in females 8% (8 cases). This incidence was in excess of other known associations of oesophageal cancer and in this series, it was exceeded only by previous gastric surgery for peptic ulceration.

The function of human purified colostral and gastrointestinal IgA has been studied by its ability to agglutinate common gastrointestinal organisms. Agglutinating activity was unaffected by trypsin or acid but it was abolished rapidly by pepsin. Both colostral and gastrointestinal IgA agglutinated a wide range of enteric organisms. Variations in this activity occurred between different individuals, and between different gastrointestinal sites in the same individual. In preliminary studies, saliva and IgA prepared from gastric and jejunal secretions in patients with pernicious anaemia showed a more uniform agglutination pattern than IgA prepared from the same sites in other patients. The agglutinin activity of IgA prepared from a particular site may be determined by the bacterial flora at that site. Agglutination methods for assessing the function of gastrointestinal antibody may be of value in the study of the possible roles of antibodies in inflammatory bowel disease.

There is increasing evidence for the importance of the secretory immune system in the gut. In studies of local antibody production it is important to have satisfactory methods for measuring immunoglobulin concentrations and to be aware of the errors which may occur. Studies on immunoglobulin measurement in intestinal secretion by the radial immunodiffusion method are reported, showing the effects of proteolytic digestion, IgA molecular size, and sampling and storage conditions. Because of the presence of monomeric IgA in addition to secretory IgA, there is no satisfactory standard for IgA in gastrointestinal secretions, and only semi-quantitative results can be given. With radial immunodiffusion, IgG and IgM when subjected to tryptic digestion, and IgA when subjected to peptic digestion, may be overestimated because of the presence of fragments of immunoglobulins. In addition, pepsin rapidly destroys IgM and IgG. Both IgM and IgG are unstable in storage. The findings suggest that immunoglobulin concentration measurements in small intestinal aspirates should be interpreted with caution. These problems are also relevant to the detection of specific antibodies in gastrointestinal secretions.

Five patients with adult acquired hypogammaglobulinaemia, four of whom were achlorhydric, were studied. Jejunal bacterial counts were much higher than those in a control group of acid secretors, but were similar to those in a control group of patients with pernicious anaemia; Giardia lamblia were isolated from the jejunal content of all patients with hypogammaglobulinaemia. The concentration of conjugated bile acids in the fasting state was lower in hypogammaglobulinaemia than in pernicious anaemia, but in the two hypogammaglobulinaemic patients with steatorrhoea there was a normal bile salt response to a fatty meal.

The sequential scintiscanning technique was used to determine gastric emptying rates in adult human subjects after ingestion of a meal of cornflakes and milk to which a gamma-emitting radioactive isotope had been added.Comparison of emptying rates using (113m)In DTPA chelate and (51)Cr sodium chromate showed that significantly slower rates were recorded with chromate, and studies in vitro demonstrated adsorption of chromate to the solid component of the meal. The results imply that the liquid phase of the gastric contents after a meal is discharged through the pylorus more rapidly than the solid phase. Scintiscanning with indium chelate provides a measurement of the emptying of the liquid phase of the gastric contents.

Jejunal biopsy specimens were obtained by means of the Crosby capsule from a normal person and from seven patients. Of these, three with primary malabsorptive disease (idiopathic steatorrhoea) had an abnormal mucosal pattern under the light microscope, and the microvilli under the electron microscope were stunted, broadened, and sparse. Two with primary malabsorptive disease had normal light microscopic appearances, and the microvilli appeared normal, while two who had appearances typical of primary malabsorptive disease under the light microscope had malignant disease of the small intestine. Of the patients with malignant disease, one had normal microvilli under the electron microscope and the other demonstrated microvilli similar to those found in primary malabsorptive disease. The former patient may have had primary malabsorptive disease in addition to the malignant change but this is uncertain, and there is no reason to believe that this was the case in the latter patient. The changes seen under the light microscope are usually of great value as an aid to diagnosis in primary malabsorptive disease but this is not always the case, and the same applies to electron microscope changes.

Duodenal calcium and magnesium concentrations after pancreatic stimulation were measured in 25 patients with and without pancreatic disease. The concentration of both ions was higher in those with pancreatic disease, and furthermore these patients showed a different secretory pattern. These findings may be relevant to the aetiology of pancreatitis and to pancreatic calcification, and might be of diagnostic value.