The relative contributions of altered gastric motor function and Helicobacter pylori-associated active chronic gastritis to the pathogenesis of functional dyspepsia are controversial. We therefore evaluated scintigraphically the intragastric distribution and gastric emptying of a mixed solid-liquid meal in 75 patients with functional dyspepsia; patients were subdivided on the basis of both specific symptom clusters and the presence or absence of H. pylori gastritis. Twenty-one (28%) patients displayed abnormal solid and/or liquid gastric emptying, with prolonged solid lag time the most prominent alteration detected. The number of patients with abnormal scintigraphic patterns increased to 36 (48%) when intragastric distribution parameters (fundal half-emptying time and antral maximal fraction) were examined. Although patients with reflux-like dyspepsia (N = 36) demonstrated significantly slower rates of liquid emptying at 45 and 70 min and a higher prevalence of abnormal liquid intragastric distribution when compared to patients with motility-like dyspepsia (N = 39) or to controls (N = 34), the absolute differences were small and unlikely to be of clinical significance. Patients without H. pylori gastritis (N = 50) demonstrated a significantly more prolonged solid lag time when compared to those with H. pylori gastritis (N = 25), but the difference was small and there were no other differences between these two subgroups.(ABSTRACT TRUNCATED AT 250 WORDS)

Aim: To assess the efficacy of cisapride therapy in relieving symptoms of functional dyspepsia. Methods: After a 2-week placebo run-in period, 61 out of 74 patients were eligible to enter a 4-week doubleblind treatment phase, consisting of treatment with cisapride (10 mg) or placebo tablets t.d.s. Gastric emptying was assessed scintigraphically at entry to the study. Patients were stratified before treatment into those with or without active chronic (Helicobacter pylorif gastritis. Patients were also classified retrospectively into those with ' reflux-like ' dyspepsia (n = 29) and those with 'motility-like' dyspepsia (n = 3 2 ) . Results: At the end of the active treatment phase, there was a similar significant (P < 0.001) reduction in total symptom score from baseline in both cisapride (8.9rt0.5 to 5.8k0.6) and placebo (9.710.6 to 5.5 f 0.6) groups. Scores for heartburn and continual bloating were significantly reduced in the cisapride but not the placebo group : improvement was attributable to patients with normal, rather than delayed, rates of gastric emptying. For continual bloating, significant improvement also occurred in the cisapride subgroup without gastritis, but not in the subgroup with gastritis (mean symptom score reduction 0.48k0.18, P = 0.03). For global evaluation by the investigator and by the patient, the overall improvement rates were not statistically different between cisapride and placebo groups. In those with normal gastric emptying, however, there was a significant (P = 0.01) improvement in general well-being in the cisapride but not in the placebo group. Conclusions : We were unable to show major differences in the short-term efficacy of cisapride and placebo in functional dyspepsia. There were indications, however, of beneficial effects of cisapride over placebo in those with 'reflux-like' dyspepsia, and in those without gastroparesis.

Psychologic distress and gastric motor dysfunction have both been implicated in the pathogenesis of functional (non-ulcer) dyspepsia (FD). This study assesses the association between psychologic factors and gastric emptying in 28 FD patients. Subjects completed an extensive range of psychologic questionnaires and underwent dual-isotope scintigraphic assessment of solid and liquid gastric emptying. Attempts to resist, control, suppress, and hold in anger, to adopt a fighting spirit whilst dealing with chronic stressors, and manifest unhappiness were predictors of prolonged gastric emptying. These findings suggest that psychologic factors may be important in the aetiology of gastric stasis and subsequent upper gastrointestinal symptoms in patients with functional dyspepsia.

24CLINICAL NOTES.-HOSPITAL MEDICINE AND SURGERY. mother who was suffering from phthisis and was suckled till within a week of the death of the mother which occurred when the child was ten months old. The home surroundings were said to be healthy. The patient was first admitted to the Royal Hospital for Sick Children and Women, Bristol, in June, 1900 (at two years of age), for otorrhoea, under the care of Mr. H. Elwin Harris, to whom 1 am indebted for leave to publish the clinical history. She was then found to have phlyctenular conjunctivitis (worse in the left eye), left facial paralysis, and a foul, purulent, sanious discharge from the left ear. She was thin, anaemic, and of sallow complexion. The spleen and liver could be felt below the ribs and her teeth were carious. There were also signs of consolidation at both apices. On Oct. 6th Mr. Harris operated on the left ear in the usual manner. In January, 1901, Klebs-Löffier bacilli were found in the nose and throat, and

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