(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."