SUMMARY To study the relationships between gastric antral and proximal duodenal motor activity, and the movement of liquid across the pylorus, 10 Currently available methods for the study of gastric emptying in man do not provide information about the movements of gastric contents in relation to individual gastric peristaltic contractions. Manometric methods permit observation of the timing and magnitude of pressure changes within the gastric lumen'l and some electrical recordings from the human stomach and duodenum have been obtained2 5 6 but although both of these give information about muscle contraction, they do not identify the movement of intragastric contents. Simultaneous studies of antral contractions and gastric emptying in man have been undertaken using intubation methods,5 7 and also with a scintigraphic procedure,8 9 but much of the current knowledge about the relationships between flow of luminal contents and contractions of the human stomach, pylorus, and duodenum has been obtained from radiological investigations using contrast media.3 10

SUMMARY A scintigraphic method is described to measure the transit of a fluid bolus through the oesophagus. Transit times in 16 normal subjects ranged from five to 15 seconds and were highly reproducible. Prolonged transit times were observed in 16 of 19 patients with known oesophageal motility disorders, and in these patients inspection of the time activity curves frequently permitted an adynamic oesophagus to be distinguished from one showing excessive incoordinate contractions. The technique was then applied prospectively to 50 patients referred for oesophageal motility studies and a comparison made between the oesophageal transit measurements and the findings on conventional oesophageal manometry. There was agreement between these tests in 42 (84%) of the 50 patients. The measurement of oesophageal transit may be made quickly and safely, without causing discomfort to the patient, and it appears to be at least as sensitive as manometry in the detection of oesophageal motility disorders.Investigation by contrast radiology and upper gastrointestinal endoscopy provides a precise diagnosis in most patients with symptoms suggestive of oesophageal disease. When such symptoms are due to oesophageal motility disorders, however, the diagnosis is often more elusive. Manometry is currently the definitive investigation whereby motility disorders may be recognised but suffers the disadvantage of causing some discomfort to the patients and demands a considerable outlay of both time and expertise in the performance of the study and in the interpretation of the recording. In consequence, a quick and reliable procedure to detect oesophageal motor dysfunction would be of considerable value.Stimulated by these considerations we have assessed a scintigraphic technique' using a radionuclide tracer and gamma camera for the quantitation of the rate of passage of bolus through the oesophagus. The procedure was first validated in normal subjects and in patients with previously diagnosed oesophageal motility disorders, and was then applied prospectively to 50 consecutive patients in whom an oesophageal motility disorder was suspected.

There is only a tendency that Vitamin E may promote HBeAg seroconversion. Therefore larger studies are needed to clarify the role of antioxidants in the therapy of chronic hepatitis B.

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