Although delayed gastric empyting is found in some patients with functional dyspepsia, there seems to be little relation between rate of emptying and symptoms. This study examined the hypothesis that food maldistribution rather than gastric stasis may equate to symptoms in such patients and used scintigraphic techniques to quantify the partition of gastric contents between proximal and distal stomach during gastric emptying. Eleven patients with functional dyspepsia characterised by chronic severe postprandial bloating without organic abnormality, and 12 healthy volunteers, ingested a standard meal labelled with technetium-99M (9mTc). Serial images of the gastric area in anterior and posterior projections were taken for 90 minutes, regions of interest for proximal, distal, and total stomach were defined, and activity time curves were derived from the geometric means of anterior and posterior counts. Total emptying in patients (median: 46 minutes; range: 30-76) was not significantly different from controls (45 minutes; 28-58) and only three showed delayed gastric emptying. In controls, food remained predominantly in the proximal half of the stomach after ingestion and then redistributed to the distal half. In the patients, however, initial activity in the proximal half after ingestion (48%; 40-65) was significantly lower (p<0.05) than in controls (60%; 39-73) and distributed more fully to the distal half of the stomach with a peak distal activity (56%; 34-58), which was consistently higher than in controls (36%; 33-42) (p<0.05). It is concluded that this subgroup of functional dyspepsia patients show abnormal intragastric distribution of food, independent of gastric emptying rate. (Gut 1994; 35: 327-332) patients with functional dyspepsia, because gastric stasis correlates poorly with symptoms9 and gastric emptying and motility can be normal in some patients despite identical symptoms.Gastric emptying is determined by the coordinated function of at least two physiologically distinct compartments of the stomach. The proximal stomach accommodates food and regulates its transfer to the distal compartment, which seems to take part in grinding and mixing intragastric contents as well as participating in the regulation of nutrient delivery to the duodedum.'0The distribution of nutrients within these two regions of the stomach have recently been studied in humans using an isotopic technique"-" to study the partitioning of an ingested test meal between a proximal and distal gastric region of interest. It has now been established that nutrients are located predominantly in the proximal stomach after ingestion with progressive distribution into the distal stomach as emptying progresses. This proximal gastric reception of ingested nutrients is consistent with animal findings that gastric fundal tone is reduced by food. So far, however, nutrient distribution in dyspeptic patients has not been explored.We examined the hypothesis that the bloating sensation experienced by some patients during and after meal ingestio...

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