Pyloric stenosis, the most common infant gastrointestinal disease, has no known etiology and clinically presents as abnormal gastric emptying with evidence of pyloric muscle hypertrophy. Whether abnormalities in gastric muscle contraction and/or relaxation have a role in this condition is poorly known, but gastroparesis is commonly observed in association with delayed gastric emptying in adults. Therefore, we evaluated the tetrahydrobiopterin (BH4)-deficient newborn mouse model of this disease (hph-1) and hypothesized that their gastric muscle properties are impaired, when compared with wild-type control animals. In vitro studies evaluating the age-dependent gastric fundus muscle contraction and relaxation potential were conducted. Compared with wild-type mice, the hph-1 stomach content/body weight ratio was significantly increased in newborn but not juvenile or adult animals, confirming abnormal gastric emptying. Gastric tissue neuronal nitric oxide synthase (nNOS) protein expression was upregulated in both newborn and adult hph-1 mice, but in the former there was evidence of enzyme uncoupling and higher tissue superoxide generation when compared with same age-matched animals. As opposed to the lack of strain differences in the U46619-induced force, the newborn hph-1 gastric muscle carbachol-induced contraction and nNOS-dependent relaxation were significantly reduced (P Ͻ 0.01). These group differences were not present in juvenile or adult mice. Preincubation with BH4 significantly enhanced the newborn hph-1, but not wild-type, gastric muscle contraction. In conclusion, changes compatible with gastroparesis are present in the newborn mouse model of pyloric stenosis. The role of BH4 deficiency and possibly associated gastroparesis in the pathogenesis of infantile pyloric stenosis warrants further investigation. pylorus; gastric emptying; nitric oxide INFANTILE HYPERTROPHIC PYLORIC stenosis (IHPS) is a relatively common condition of unknown etiology and pathogenesis. Infants with this condition seldom exhibit any abnormalities at birth. The gastric outlet obstruction develops at 2-12 wk of life, and the pyloric sphincter hypertrophy quickly resolves after pyloromyotomy, a surgical intervention involving the longitudinal incision of the circular muscle (23,27,28).IHPS has traditionally been seen as a condition resulting from failure of the pyloric sphincter muscle to relax, thus preventing adequate and rapid gastric emptying following a meal. Infants with IHPS have a lower plasma nitrate level when compared with age-matched controls, and, following pyloromyotomy, the nitrate concentration increases to values found in normal infants (17). The pyloric tissue neuronal nitric oxide synthase (nNOS) expression is reduced in subjects with IHPS (1). Given nNOS role in NO generation, this has been postulated to play a significant role in the muscle hypertrophy and reduced sphincter relaxation observed in this condition.Gastric motility is regulated through enteric nervous system activity and involves both excitatory cholin...