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SUMMARY The effects of intragastric infusion of 10% Intralipid and 10% dextrose on the intraluminal pressures in the antrum, pylorus and duodenal bulb have been examined. Ten studies with each infusate have been performed in 10 normal subjects and the results compared with those obtained previously in 22 studies during intragastric infusion of isotonic saline. During saline infusion, contractile activity varied. In six studies fasting motor activity persisted; in the remainder, variable activity, without recognisable pattern was recorded. With saline, the gastroduodenal region usually functioned as a unit and the pylorus was the least autonomous part. Neither a sustained rise of basal pressure nor rhythmic, independent contractions were recorded from the pylorus. The contractile activity of the gastroduodenal region with Intralipid and dextrose was more uniform than with saline. Fasting motor activity was always abolished. The gastroduodenal region ceased to contract as a unit and the pylorus acquired autonomous activity. Rhythmic, independent contractions of the pylorus were recorded in nine of 10 studies during Intralipid infusion and six of 10 studies with dextrose. In addition, a sustained rise in pyloric basal pressure was recorded in eight of 10 studies with Intralipid and three of 10 studies with dextrose. Pyloric motility indices were significantly greater with fat than with dextrose. The observed differences in gastroduodenal motility are consistent with a role for the pylorus in the control of emptying of liquid from the stomach.Disagreement persists concerning the motility of the pylorus and gastroduodenal region. In dogs' and man2 3a raised basal pressure which was increased by intraduodenal infusion of fat or acid, has been recorded from the pylorus by some workers. Using the same techniques, however, others have failed to reproduce these results.-8 Berger,9 using a photoelectric device to register closure of the pylorus, showed that the normal human pylorus was usually open and contracted only when a contraction passed through the gastroduodenal region. Thus the pylorus does not appear to have an independent action and the whole gastroduodenal region acts as a unit.In a recent studyl we have used a different technique to obtain recordings of intraluminal pressure simultaneously from the antrum, pylorus, and duodenal bulb of normal subjects during intragastric infusion of isotonic saline. Under these Address for correspondence: Mr J Alexander-Williams FRCS, The General Hospital. Steelhouse Lane, Birmingham B4 6NH. Received for publication 25 February 1983 conditions the pylorus did not have an independent action. The studies with saline represent the effects of distension of the gastroduodenal region by an inert liquid. We have now used the same technique to examine the effects of distension with two nutrient liquids, 10% Intralipid and 10% dextrose. The effects of saline, fat and dextrose on gastroduodenal motility have been compared. Methods SUBJECTSAll subjects were healthy volunteers. In the ...

A method of recording continuously and simultaneously the intraluminal pressure in the antrum, pylorus, and duodenal bulb has been used to study gastroduodenal motility during intragastric infusion of saline. Twenty-two studies were performed in 15 normal individuals. Two types of contraction were recorded: (1) independent contractions of the individual parts of the gastroduodenal region, and (2) related contractions of the antrum, pylorus, and duodenal bulb, resulting in a concerted contraction of the whole region. The majority of pyloric contractions were part of a concerted contraction of the whole gastroduodenal region during which the pylorus behaved as the terminal part of the antrum. The majority of duodenal contractions were not associated with pyloric contractions, only 21.7% of duodenal contractions coincided with closure of the pylorus. This suggests that under the conditions of this study the pylorus was not acting as a barrier to reflux. An elevated basal pressure was never recorded from within the pylorus; apart from a brief closure during contraction, the pylorus is always open.

SUMMARY A consecutive series of 12 patients with stenosis secondary to duodenal ulceration were treated by proximal gastric vagotomy (PGV) and duodenoplasty or PGV and dilatation of the stenosis. Three months after operation the rate and pattern of gastric emptying of a solid meal was measured in each patient and compared with 18 patients with uncomplicated duodenal ulcer treated by PGV alone. Two patients developed gastric stasis in the early postoperative period which resolved with medical treatment. All patients were asymptomatic and were eating normally three months after operation. There was no significant difference in the rate of gastric emptying postoperatively between the patients who had stenosis and those who had uncomplicated duodenal ulcers. These results indicate that despite early postoperative difficulties in some patients pyloric dilatation or duodenoplasty with PGV are both effective treatments for stenosis due to duodenal ulceration.The superior early results of proximal gastric vagotomy (PGV) compared with other operations for duodenal ulcer are due to the preservation of an intact and innervated pyloric antrum (Johnston and Wilkinson, 1970;Clarke and Williams, 1972;Amdrup et al., 1974). However, gastric outlet obstruction is usually considered a contraindication to PGV unless it is combined with a drainage procedure. Pyloric or duodenal stenosis due to duodenal ulceration is usually treated by procedures that destroy the pylorus or bypass the pyloric antrum and are therefore likely to produce dumping, diarrhoea and bile vomiting (Wastell, 1969;Goligher, 1970).Johnston suggested that patients with duodenal ulcer complicated by stenosis should be treated by PGV and dilatation of the stenosis (Johnston et al., 1973). He also reported that the symptomatic results in patients with pyloric stenosis were better after PGV and dilatation than after truncal vagotomy and drainage (McMahon et al., 1976). Duodenoplasty is an alternative method of treating the stenosis without destroying the pylorus. The symptomatic results of PGV and duodenoplasty in 25 patients with pyloric stenosis were indistinguishable from those in patients with uncomplicated ulcer treated by PGV alone

A consecutive series of 35 patients with acute obstruction due to carcinoma of the left colon (29) or rectum (six) were treated by primary resection with anastomosis. The operation usually took the form of a left hemicolectomy or sigmoid resection without a proximal colostomy. There were three operative deaths (8.5 percent) due to anastomotic dehiscence, bronchopneumonia, and pulmonary embolism, respectively. Nonlethal complications occurred in ten patients (anastomotic leakage in three, a ureteric fistula in one, and wound infection in six). The mean duration of hospital stay in patients without complications was 18 days (range, 12 to 35). The morbidity and mortality in this series did not exceed the cumulative morbidity and mortality that would be expected after staged surgery. Compared with staged surgery, immediate resection and anastomosis, by avoiding the problems of colostomy and reducing the length of hospital stay, have significant advantages for the patient.