SUMMARY The effect of metoclopramide has been studied on the emptying of solid meals labelled with 51Cr and monitored with a gamma camera.Metoclopramide, 10 mg iv or a dummy injection, was given randomly and double blind to 10 normal subjects and to 10 patients within three months of a truncal vagotomy and pyloroplasty. All were tested in the recumbent position.Metoclopramide had no effect on emptying rates in the normal subjects nor in four postvagotomy patients who had emptying within the normal range (T1 30-150 min). In six patients with abnormally delayed emptying (mean TI 369 min) metoclopramide produced a significant improvement (mean TI 194 min, P < 001).The actions of metoclopramide in stimulating gastric peristalsis and speeding up gastric emptying were first described by Justin-Besan9on, Grivaux, and Watterz (1964). The influence of metoclopramide on the rate of emptying of liquids from the stomach has been studied by several investigators. Connell and George (1969), using a dye dilution technique, found that metoclopramide accelerated gastric emptying and that it was most effective when emptying was delayed. This technique was also used by Howard and Sharp (1973) who showed that the delayed emptying of a fluid meal in women during labour was significantly accelerated by metoclopramide. The rate of gastric emptying during a barium meal was found to be increased by metoclopramide (James and Hume, 1968;Kreel, 1970). The effect of metoclopramide on the gastric emptying of solid meals has not been reported, so we describe here the results of a double-blind trial of metoclopramide (Primperan) in normal subjects and in patients with duodenal ulcer soon after truncal vagotomy and pyloroplasty. We chose this group of patients as they have been shown in a previous study to have a slow emptying rate compared with normal subjects when 'Primperan (Berk Pharmaceuticals) 'Requests for reprints to Mr

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SUMMARYThe effect of posture on gastric emptying of et al., 1973). Measurements of gastric emptying rates have produced conflicting results, partly because of the variable conditions under which the tests have been carried out. Variables of particular importance are the composition of the meal, the posture adopted by the subject during the test and the method of measurement. There is some evidence to suggest that liquids normally leave the stomach more rapidly than solids (Heading et al., 1971), and in dogs this is more marked after vagotomy (Wilbur and Kelly, 1973). The effect of posture has been studied only with liquid meals, which in patients after vagotomy leave the stomach more rapidly when the subject is seated than when he is lying on the left side (McKelvey, 1970).Our understanding of the effects of various types of vagotomy on gastric emptying of solid meals might inff uence the choice of operation and a knowledge of the effect of posture might affect the management of the sequelae. In this study the effect of truncal vagotomy and pyloroplasty and of highly selective vagotomy (Johnson and Wilkinson, 1970) on the rate of emptying of solid meals is reported. The effect of posture on the emptying rate is reported in normal individuals and in patients after both types of vagotomy. A solid meal was labelled with radioactive 51Cr and the rate of emptying measured with a gamma camera. Materials and methodsThe subjects studied were 10 healthy volunteers, 5 patients within 3 months after truncal vagotomy and pyloroplasty and 5 patients within 3 months after highly selective vagotomy. The rate of gastric emptying was studied on two occasions in each subject; once while lying down and once while standing. The mean time interval between tests was 7 days for normal subjects and 5 days for each group of postvagotomy patients. In postoperative patients the order in which the two tests were carried out was randomized to eliminate the effect of recovery which occurs within the first 3 months after truncal vagotomy (Cowley et al., 1972).The method chosen was a modification of that described by Jones et al. (1970). A standard meal was labelled with W r and a record of the rate at which it left the stomach was made by continuous monitoring with a gamma camera. The meal consisted of half a cupful of instant porridge (Ready Brek), 250ml of milk, half of which was used to make the porridge and one thick slice of lightly buttered bread and marmalade; 200 pCi of 51Cr as sodium chromate were mixed with the porridge during its preparation. The meal was eaten whilst the subject was seated, and after finishing the meal he lay supine under the gamma camera in one test or stood against the camera in the other. During recording in the recumbent position the subject lay in the same position for 90 minutes. In the standing test, recordings were taken for 24 minutes at intervals of 7 minutes, so that the subject could move between recordings. The camera was centred over the stomach with the aid of an oscilloscope display, and by placi...

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