There is increasing evidence that gastric ulceration is the result of an incompetent pyloric sphincter allowing reflux into the stomach 1 • 2 • Duodenal contents, containing bile and other substances, lower gastric mucosal resistance and the resulting gastritis, more common in the antrum, predisposes to gastric ulceration 3 • 4 • The normal pyloric sphincter not only has some effect on the gastric emptying of liquids and the selection of particulate size of solids, but also prevents duodenogastric reflux. Why does an apparently normal pylorus sometimes allow reflux to occur? To prevent reflux the timing of pyloric closure is important, as any process which upsets this dynamic sequence of events in the antropyloric and duodenal regions causes an alteration in the rate of gastric emptying and/or duodenal reflux s .Local, hormonal or neural factors may affect the motility of this region. Fisher and Cohen 6 have described pyloric dysfunction in gastric ulcer patients when cholecystokinin and secretin failed to increase the pyloric pressure when compared with normal subjects. They suggested that this lack of response could explain why the pyloric sphincter allows reflux. This paper describes a method of direct endoscopic measurement of the pyloric diameter and the assessment of pyloric tone and their response to exogenous cholecystokinin.
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