SUMMARY Gastrointestinal motor function in patients with primary anorexia nervosa has rarely been investigated. We studied oesophageal motor activity in 30 consecutive patients meeting standard diagnostic criteria for primary anorexia nervosa (Feighner et al; DSM III). Seven were found to suffer from achalasia instead of primary anorexia nervosa, one from diffuse oesophageal spasm and one from severe gastro-oesophageal reflux and upper oesophageal sphincter hypertonicity, while partly non-propulsive and repetitive high amplitude, long duration contractions prevailed in the lower oesophagus of another six. In four patients with oesophageal dysmotility not responding to therapy and in 12 of 15 patients with normal oesophageal manometry, gastric emptying of a semisolid meal was studied. Emptying was normal in only three but markedly delayed in 13 cases (half emptying times 97-330 min, median: 147 min, as compared with 21-119 min, median: 47 min, in 24 healthy controls). In eight patients, the effects of domperidone 10 mg iv and placebo were compared under random double blind conditions. Half emptying times were shortened significantly (p<0.01) by domperidone. Conclusions: (1) symptoms of disordered upper gastrointestinal motor activity may be mistaken as indicating primary anorexia nervosa; (2) clinical evaluation of patients with presumed primary anorexia nervosa should rule out the possibility that disordered oesophageal motor activity underlies the symptoms; (3) delayed gastric emptying is a frequent feature in primary anorexia nervosa and might be returned to normal with domperidone.

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(Gut 1993; 34: 166-172) The macrolide antibiotic, erythromycin, has been shown to induce effects on gastrointestinal motor activity closely resembling those of the polypeptide motilin.'2 The facts that erythromycin displaces motilin bound to its receptor,34 induces contractions in the gastrointestinal tract through the same mechanism as motilin,35' and displays the same regional and species specificities as motilin,3 suggest that erythromycin acts as a motilin agonist.47 Moreover, the ability of erythromycin derivatives to displace motilin correlates with their ability to induce contractions,' and for one erythromycin derivative it has been shown in binding experiments that the interaction with motilin was a competitive one.4 As motilin receptors are abundant on the muscle cells of the human gastric antrum and the proximal duodenum,8 erythromycin and its derivatives may constitute a new group of agents, which could be of therapeutic value in patients with disordered gastroduodenal motor function. This is suggested also by preliminary results of studies in, albeit small, numbers ofpatients with such disorders. In abstract form, it has been reported that erythromycin enhanced gastric evacuation in 'many' of eight patients with delayed emptying after vagotomy and antrectomy9 and in four of five individuals with idiopathic or diabetic gastroparesis. '0 The results of a study published in full showed that, in patients with diabetic gastroparesis, erythromycin accelerated gastric emptying not only when administered as a single intravenous dose, but also when given orally over a four week period."

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