THE AMERICAN JOURNAL OF GASTROENTEROLOGY
1, 2000
© 2000 by Am. Coll. of Gastroenterology
Published by Elsevier Science Inc.
Long-Term Effects of Pyloromyotomy on
Pyloric Motility and Gastric Emptying in Humans
W. M. Sun, Ph.D., S. M. Doran, K. L. Jones, Ph.D., G. Davidson, M.B.B.S., Ph.D.,
J. Dent, M.B.Ch.B., Ph.D., and M. Horowitz, M.B.B.S., Ph.D.
Departments of Medicine and Gastrointestinal Medicine, Royal Adelaide Hospital, and the Gastroenterology
Unit, Women’s and Children’s Hospital, Adelaide, South Australia, Australia
OBJECTIVE: The aim of this study was to determine the long
term effects of pyloromyotomy for infantile hypertrophic py-
loric stenosis (IHPS) on gastric emptying and pyloric motility.
METHODS: Concurrent measurements of gastric emptying
and antropyloroduodenal pressures were performed in six
volunteers (aged 24 –26 yr) who had had pyloromyotomy
performed in infancy because of IHPS, and in six normal
subjects. Subjects were studied on 2 days, once sitting and
once in the left lateral position. Gastric emptying of 300 ml
25% dextrose labeled with 20 MBq 99mTc sulfur colloid was
measured. Antropyloroduodenal motility was evaluated
with a sleeve/multiple sidehole manometric assembly,
which was also used to deliver an intraduodenal triglyceride
infusion at 1.1 kcal/min for 60 min, starting 30 min after
ingestion of the dextrose.
RESULTS: In both body positions, gastric emptying and in-
tragastric distribution of the drink did not differ between the
two groups. In both groups and postures, the amount emp-
tied was less during intraduodenal lipid infusion. The num-
ber (p ⬍ 0.01) and amplitude (p ⬍ 0.02) of isolated pyloric
pressure waves (IPPWs) was greater in the control subjects,
whereas basal pyloric pressure was greater in the pyloro-
myotomy subjects (p ⬍ 0.02). In both groups, the rate of
gastric emptying in the sitting position was related to the
number of IPPWs (r ⱖ 0.40, p ⬍ 0.05), but not to basal
pyloric pressure.
CONCLUSIONS: These results indicate that, in adults who
have had pyloromyotomy for IHPS in infancy, patterns of
pyloric motility are abnormal; pyloric tone is higher,
whereas the number and amplitude of phasic pyloric pres-
sure waves are less. In contrast, the overall rate of gastric
emptying of a nutrient liquid meal is normal. These obser-
vations are consistent with the concept that the stomach has
the capacity to compensate for changes in pyloric motility to
minimize effects on gastric emptying. (Am J Gastroenterol
2000;95:92–100. © 2000 by Am. Coll. of Gastroenterology)
INTRODUCTION
The results of previous studies suggest that the pylorus plays
an important role in the regulation of gastric emptying in
Vol. 95, No.
ISSN 0002-9270/00/$20.00
PII S0002-9270(99)00764-9
humans by acting as a brake (1–3). For example, in normal
subjects, infusion of nutrients into the small intestine stim-
ulates tonic and phasic pressure waves that are localized to
the pylorus and retards gastric emptying (1, 4). In addition,
in animals, excision of the pylorus and pyloroplasty are
associated with more rapid gastric emptying (5– 8). There
are, however, no technically adequate studies that have
evaluated the effects of impaired pyloric motor function on
gastric emptying in humans. It is well recognized that, in
patients who have had pyloroplasty for the treatment of
peptic ulcer disease, gastric emptying of liquids is more
rapid, particularly when patients are standing or seated,
because of the effects of gravity. However, such patients
have nearly all had a gastric resection and/or vagotomy
performed (9). Accordingly, the effect of impaired pyloric
function alone is uncertain. It cannot be assumed that the
latter will be associated with more rapid emptying, as the
mechanisms that regulate transpyloric flow are complex and
dependent on the integration of motor activity in different
regions of the stomach and small intestine (10). In particu-
lar, animal studies indicate that the stomach has the capacity
to compensate when the function of one of these regions is
modified, so that effects on the overall rate of emptying may
be minimal (10, 11).
Infantile hypertrophic pyloric stenosis (IHPS), associated
with pyloric obstruction, is a common problem. This con-
dition is usually treated by pyloromyotomy; the hypertro-
phic circular musculature is incised, via either an open or,
more recently, a laparoscopic approach. The effects of py-
loromyotomy for IPHS on pyloric motor function have not
been evaluated; if pyloric motility was abnormal, informa-
tion about the impact of impaired pyloric motor function per
se on gastric emptying in humans would be obtained.
In this study we have evaluated the long term effects of
pyloromyotomy for IHPS on pyloric motility in response to
both a nutrient drink and small intestinal lipid infusion. The
broad hypothesis was that, if pyloromyotomy is associated
with impaired pyloric motility, gastric emptying of a nutri-
ent liquid would be accelerated, particularly when the
influence of gravity is greater, and the retardation of
gastric emptying by small intestinal nutrient stimulation
diminished.
AJG – January, 2000
MATERIALS AND METHODS
Subjects
Six male volunteers (aged 24 –26 yr, body mass index
[BMI] 24 –28 kg/m2) who had had a pyloromyotomy for
treatment of IHPS were recruited after reviewing case notes
at the Adelaide Women’s and Children’s Hospital, Ad-
elaide, South Australia. Initially, 30 subjects were randomly
selected and attempts were made to invite them, either by
letter or by telephone, to participate in the study. Six of these
agreed to participate; the majority of the remaining patients
could not be located. In all cases, a Ramstedt operation was
performed at ⱕ6 wk by various surgeons. Six healthy male
volunteers (aged 20 –25 yr, BMI 22–28 kg/m2) served as
controls. The protocol was approved by the Research Ethics
Committees of the Royal Adelaide Hospital and the Wom-
en’s and Children’s Hospital.
Protocol
Simultaneous measurements of antropyloroduodenal pres-
sures and gastric emptying were performed in each subject.
To test the effects of gravity, subjects were studied on 2
separate days, once in the sitting and once in the left lateral
position. The order of the 2 study days was randomized and
they were separated by ⱖ3 days. On each study day, after an
overnight fast, a manometric assembly (see below) was
passed into the stomach via an anesthetized nostril, and the
sleeve sensor was positioned across the pylorus using mea-
surements of antral and duodenal transmucosal potential
difference (TMPD) (4). Once the manometric assembly was
correctly positioned, basal antropyloroduodenal pressures
were measured for 30 min. The subject then drank 300 ml
of 25% dextrose, which had been labeled with 20 MBq
99m
Tc sulfur colloid, within 2 min (12). The temperature of
the drink was 37°C (13). Thirty minutes after the drink, a
10% triglyceride emulsion (Intralipid 10%, Vitrum, Stock-
holm, Sweden) at a rate of 1 ml/min (1.1 kcal/ml) was
infused intraduodenally for 1 h. Gastric emptying was mon-
itored for 60 min after completion of the lipid infusion, or
until 90% of the liquid had emptied.
Measurements
GASTRIC EMPTYING. Gastric emptying was measured
scintigraphically. Starting from the time of completion of
the drink, data were acquired every 30 s for the first 30 min
and at 3-min intervals thereafter. Data were corrected for
subject movement, radionuclide gamma ray attenuation, and
radionuclide decay (12, 14). Correction for attenuation was
performed using factors derived from a lateral image of the
stomach (12). A region of interest (ROI) was drawn around
the total stomach, which was then divided into proximal and
distal regions, with the proximal region corresponding to the
fundus and proximal corpus and the distal region represent-
ing the distal corpus and antrum (14). Gastric emptying
curves were derived for total, proximal, and distal stomach
(expressed as percent retention over time). The lag phase
Effects of Pyloromyotomy on Pyloric Motility 93
(before any of the drink emptied from the stomach), and the
half emptying time (T50) were also measured (12, 14).
ANTROPYLORODUODENAL PRESSURES. The 11-lu-
men manometric assembly used to measure antropyloric
pressures incorporated a sleeve sensor 4.5 cm long in par-
allel with an array of four sideholes spaced at 1.5-cm inter-
vals (13, 15). The sideholes at each end of the sleeve
recorded both intraluminal pressure and transmucosal po-
tential difference (TMPD). The sideholes along the sleeve
allowed pressure waves isolated to the pylorus (IPPWs) to
be identified (15). Gastric antral pressures were sampled at
7.5, 6.0, 4.5, 3.0, and 1.5 cm orad to the antral TMPD port.
A port 10 cm aborad to the distal end of the sleeve was used
to infuse the triglyceride emulsion (4). All manometric
sideholes were perfused with degassed, distilled water at 0.6
ml/min, except the TMPD sideholes which were perfused
with degassed normal saline at the same rate. Manometric
signals were detected by pressure transducers (Transpac,
Abbott Critical Care Systems, North Chicago, IL) coupled
to two eight-channel Polygrafs (Synectics, Sweden). The
amplified signals were digitized on line at 10 samples/s
using an A/D board (NB-MIO16, National Instruments,
TX). Digitized values were stored in an Apple Macintosh
Quadra 700 computer using software (Mad 16, C. Malbert/
Royal Adelaide Hospital/Synectics) written with LabView
(National Instruments, Austin, TX).
Recordings were analyzed only when the sleeve sensor
was positioned correctly according to the following criteria:
the antral TMPD was ⱕ ⫺20 mV, the duodenal TMPD was
ⱖ⫺15 mV, and the difference between the two readings
was ⱖ15 mV (15). The analysis included all pressure waves
ⱖ10 mm Hg in amplitude that lasted 5–25 s (15). Isolated
pyloric pressure waves (IPPWs) were defined as pressure
waves that were detected by the sleeve sensor and no more
than one sidehole within the sleeve length, in the absence
(⫾5 s) of an associated pressure wave of any magnitude that
was ascribable to either gastric or duodenal contraction (4,
15). Basal pyloric pressure was defined as the difference
between the basal pressure recorded by the sleeve sensor
and distal antral pressure (1.5 cm orad to the antral TMPD
channel) (4, 15). For each 15-min interval, the amount of the
time that basal pyloric pressure was ⬍2 mm Hg was cal-
culated. The total number of antral and duodenal pressure
waves (from 0 to 150 min) was counted.
Statistical Analysis
Gastric emptying, the number and amplitude of IPPWs, and
basal pyloric pressure were evaluated over 15-min time
intervals from the time of completion of the drink. Data
were evaluated by analysis of variance (ANOVA) for re-
peated measures (StatView, Abacus Concepts, Berkeley,
CA). The relationships between gastric emptying and IP-
PWs and pyloric tone were assessed by the multiple regres-
sion coefficiency test. Data were distributed normally and
94 Sun et al.
are represented as mean ⫾ SEM. A value of p ⬍ 0.05 was
considered significant.
RESULTS
Gastric Emptying (Fig. 1)
SITTING POSITION. There was no difference in gastric
emptying from the total stomach between the two groups
(e.g., the lag phase was 6 ⫾ 3 min vs 5 ⫾ 4 min, the
intragastric retention at 30 min 84% ⫾ 4% vs 90% ⫾ 3%,
and the T50 136 ⫾ 10 min vs 149 ⫾ 10 min, in the
pyloromyotomy and control groups respectively; p ⬎ 0.05
for all). There were also no significant differences in intra-
gastric distribution of the drink between the two groups. In
both groups, the rate of emptying during intraduodenal lipid
infusion (30 –90 min) was less than that after the cessation
of lipid infusion (90 –150 min) (pyloromyotomy group: 20%
⫾ 2% vs 43% ⫾ 9%, p ⬍ 0.05; control group: 17% ⫾ 4%
vs 36% ⫾ 8%, p ⬍ 0.05).
LEFT LATERAL POSITION. There were no differences
either in gastric emptying from the total stomach or in
intragastric distribution between the pyloromyotomy and
control groups (lag phase 7 ⫾ 2 min vs 7 ⫾ 4 min, retention
at 30 min 92% ⫾ 3% vs 93% ⫾ 4%, and T50 127 ⫾ 6 min
vs 136 ⫾ 6 min, in the pyloromyotomy and control groups,
respectively; p ⬎ 0.05 for all). In both groups, the amount
emptied during intraduodenal lipid infusion (30 –90 min)
was less than the amount emptied after cessation of this
infusion (90 –150 min, although this difference was not
significant in the pyloromyotomy group) (pyloromyotomy
group: 20% ⫾ 3% vs 33% ⫾ 9%, p ⫽ 0.18; control group:
8% ⫾ 5% vs 36% ⫾ 8%, p ⬍ 0.02). The amount emptied
during the intraduodenal lipid infusion was greater in the
pyloromyotomy group when compared to the control group
(20% ⫾ 3% vs 8% ⫾ 5%, p ⬍ 0.02).
COMPARISON BETWEEN SITTING AND LEFT LAT-
ERAL POSITIONS. There were no significant differences
(p ⬎ 0.05) in total stomach emptying or intragastric distri-
bution between the sitting and left lateral positions.
Antropyloroduodenal Pressures
PYLORIC PRESSURES. After ingestion of dextrose, there
was an increase in the rate of IPPWs. In the left lateral
position, this occurred in both groups (p ⬍ 0.02 for both); in
the sitting position, a significant increase (p ⬍ 0.02) was
evident only in the control subjects (Fig. 2). Intraduodenal
lipid stimulated IPPWs (p ⬍ 0.05) in both postures in the
control group, but there was no clear stimulation of IPPWs
in the pyloromyotomy group. Accordingly, the rate of IP-
PWs during intraduodenal lipid infusion was greater (p ⬍
0.02) in the control subjects. There was no significant dif-
ference in the number of IPPWs between the sitting and left
lateral position in either group. The amplitude of IPPWs was
greater (p ⬍ 0.02) in the control than the pyloromyotomy
group in both postures (Fig. 3). This difference was evident
AJG – Vol. 95, No. 1, 2000
before ingestion of the drink (p ⬍ 0.05).
Basal pyloric pressure was greater (p ⬍ 0.02) in the
pyloromyotomy group when compared to the control group,
with no difference between the two body postures (Fig. 4).
This difference was evident (p ⬍ 0.05) before ingestion of
the drink. In the left lateral position there was a time-
dependent reduction in basal pyloric pressure in the pylo-
romyotomy group (p ⬍ 0.05). The percentage of time that
basal pyloric pressure was ⬍2 mm Hg was less in the
pyloromyotomy group when compared to control group
(p ⬍ 0.01 for both postures), with no difference between the
two postures (Fig. 5). This difference was evident (p ⬍
0.01) before ingestion of the drink.
ANTRAL AND DUODENAL PRESSURES. There were
no differences between the two groups or postures in the
total number of antral waves (sitting: 81 ⫾ 13 vs 78 ⫾ 26;
left lateral position: 102 ⫾ 15 vs 87 ⫾ 16; pyloromyotomy
vs control group, respectively, p ⬎ 0.05 for both). Similarly,
there were no significant differences in the number of du-
odenal pressure waves between the groups in either posture
(sitting: 68 ⫾ 21 vs 72 ⫾ 33; left lateral position: 120 ⫾ 29
vs 110 ⫾ 30; pyloromyotomy vs control group, respectively;
p ⬎ 0.05 for both).
Relationships Between Gastric
Emptying and Pyloric Pressures (Fig. 6)
In the sitting position, there was an inverse relationship
between gastric emptying and the number of IPPWs (r ⱖ
⫺0.40, p ⬍ 0.05), but not basal pyloric pressure (r ⱕ 0.20,
p ⬎ 0.05) in both groups. In the left lateral position, there
was an inverse, but nonsignificant, relationship between the
rate of gastric emptying and the number of IPPWs in the
pyloromyotomy group (r ⫽ ⫺0.34, p ⫽ 0.18), which was
not evident in the control (r ⫽ 0.10, p ⬎ 0.05) subjects.
There were no significant relationships between gastric
emptying and the amplitude of IPPWs (data not shown). In
the left lateral position, there was no significant relationship
between gastric emptying and basal pyloric pressure in
either group (r ⱕ 0.10, p ⬎ 0.05). There were also no
significant relationships between gastric emptying and the
amount of time that basal pyloric pressure was ⬍2 mm Hg,
in either group or in either posture.
DISCUSSION
In the intact stomach, the rate of gastric emptying of nutrient
containing liquids and “liquefied” solids is dependent on the
integration of motor activity in the proximal stomach, an-
trum, pylorus, and proximal small intestine (10), which is
modulated by feedback from receptors in the lumen of the
small intestine (4, 16, 17). Gastric emptying of low nutrient
liquids is also influenced by passive forces generated by
intragastric volume and gravity (14, 18). The results of
studies in normal subjects (1, 19) and animals (5– 8) indicate
that phasic and tonic pressures localized to the pylorus are
AJG – January, 2000 Effects of Pyloromyotomy on Pyloric Motility 95

Figure 1. Gastric emptying curves for total, proximal, and distal stomach in the sitting and left lateral positions in pyloromyotomy and
control groups. Intraduodenal lipid was infused for 60 min (t ⫽ 30 –t ⫽ 90 min). Data are mean values ⫾ SEM.
96 Sun et al. AJG – Vol. 95, No. 1, 2000

Figure 2. Frequency of isolated pyloric pressure waves (IPPWs) in the sitting and left lateral positions in pyloromyotomy and control
groups. The timing of consumption of the drink and the intraduodenal lipid infusion are indicated. Data are mean values ⫾ SEM. The p
values indicate the comparison between control and pyloromyotomy groups by analysis of variance.

important in the regulation of gastric emptying; for example
the stimulation of pyloric motility by infusion of nutrients
into the small intestine is capable of producing sustained
cessation of transpyloric flow (19). The “braking” effect of
the pylorus, accordingly, may be particularly important in
controlling gastric emptying of nutrient liquids and when
gravity favors gastric emptying.
Our study has established for the first time that, after
pyloromyotomy for IHPS, the pylorus exhibits both isolated
pyloric pressure waves and basal pyloric pressure, and that
there are substantial differences in both of these motor
mechanisms compared to those in normal subjects. In par-
ticular, 1) phasic motor activity is less than normal; and 2)
basal pyloric pressure is higher. The absence of any change
in the overall pattern of gastric emptying of a liquid meal
after pyloromyotomy is consistent with previous observa-
tions (20 –24), and the concept that the stomach is capable
of considerable compensation before the overall rate of

Figure 3. Amplitude of isolated pyloric pressure waves (IPPWs) in the sitting and left lateral positions in pyloromyotomy and control
groups. The timing of consumption of the drink and the intraduodenal lipid infusion are indicated. Data are mean values ⫾ SEM. The p
values indicate the comparison between control and pyloromyotomy groups by analysis of variance.
AJG – January, 2000 Effects of Pyloromyotomy on Pyloric Motility 97

Figure 4. Basal pyloric pressure in the sitting and left lateral positions in pyloromyotomy and control groups. The timing of consumption
of the drink and the intraduodenal lipid infusion are indicated. Data are mean values ⫾ SEM. The p values indicate the comparison between
control and pyloromyotomy groups by analysis of variance.

emptying is modified substantially (25): i.e., gastric empty-
ing is controlled by a variety of mechanisms that vary
according to the state of gastric filling and the nutrient/
osmotic density of what is emptying, so that changes in
pyloric motility per se (in the absence of obstruction) may
not always be associated with effects on gastric emptying. It
is possible that the increase in basal pyloric pressure mini-
mizes the potential impact of reduction in IPPWs on gastric
emptying after pyloromyotomy for IHPS.
The preservation of both isolated pyloric pressure waves
and basal pyloric pressure after pyloromyotomy is not sur-
prising. The results of ultrasound (20, 21) and radiological
(22–24) studies suggest that the function of the pylorus is
“normal” 2–12 wk after the operation. Although there is

Figure 5. The amount of time (%) that basal pyloric pressure was ⬍2 mm Hg in the sitting and left lateral positions in pyloromyotomy
and control groups. The timing of consumption of the drink and the intraduodenal lipid infusion are indicated. Data are mean values ⫾
SEM. The p values indicate the comparison between control and pyloromyotomy groups by analysis of variance.
98 Sun et al.
Figure 6. Relationship between gastric emptying and the frequency of isolated pyloric pressure waves (IPPWs) in the sitting and left lateral
positions in (A) control and (B) pyloromyotomy groups.
limited information about the morphological effects of py-
loromyotomy (26), it may be expected that incision of the
smooth muscles would heal relatively rapidly. The intermit-
tent occurrence of increased basal pyloric pressure also
cannot be explained by scarring; and scarring is not an
expected consequence of pyloromyotomy. It should also be
recognized that the impaired development of the interstitial
cells of Cajal (27–29) and reduction in nitric oxide synthase
activity (30) in the enteric nervous system that characterize
IHPS are reversible (at least in part) over time, in many
cases (26). We demonstrated that the number and amplitude
of isolated pyloric pressure waves was reduced after pylo-
romyotomy. This is most likely a result of the surgical
procedure, although it could potentially also be inherent in
the disease process. In particular, Cullen and Kelly (5)
reported that, in dogs, pyloroplasty reduces the amplitude,
but not the frequency, of IPPWs in the fasted and postpran-
dial states, as well as during intraduodenal nutrient infusion.
In contrast to the reduced number of IPPWs, basal pyloric
pressure was greater than normal in the patient group, this
AJG – Vol. 95, No. 1, 2000
difference being evident before ingestion of the drink. The
etiology of the increase in basal pyloric pressure is uncer-
tain; intuitively it is less likely to be attributable to surgery
than a long term effect of IHPS on pyloric motility (26, 28,
29), but this issue can only be resolved by cross-sectional or,
ideally, longitudinal studies. An analogy can be made to
achalasia, in which treatment may result in symptomatic
improvement despite abnormal esophageal peristaltic am-
plitude.
We have reported previously that the rate of emptying of
a nutrient liquid is inversely related to the number of IPPWs
in normal subjects (31) and examined this relationship in the
current study to determine whether pyloric mechanics differ
from normal after pyloromyotomy. After pyloromyotomy
the rate of gastric emptying was also inversely related to the
number of IPPWs in the sitting position. Although the
absence of a significant relationship between gastric emp-
tying and basal pyloric pressure is consistent with our pre-
vious study in normal subjects (31), the possibility of a type
II error cannot be excluded, as both the number of subjects
AJG – January, 2000
and range of basal pyloric pressures were relatively small.
The observed relationship between the rate of gastric emp-
tying and the number of IPPWs, as well as the slowing of
gastric emptying during the intraduodenal lipid infusion in
the sitting position, suggest that IPPWs are functionally
significant after pyloromyotomy. In contrast to our previous
study (14), gastric emptying was not faster in the sitting
when compared to the left lateral position in either the
control subjects or pyloromyotomy group. This is likely to
be because the nutrient density and osmolality of the drink
were relatively high (25% dextrose compared to normal
saline) in our previous study (14), so that small intestinal
feedback was greater. Potentially, differences may have
been evident with the use of a drink of greater volume.
Further studies are indicated to evaluate the effects of py-
loromyotomy on gastric emptying of solids; there is evi-
dence that the pylorus normally acts as a barrier to the
passage of larger solid particles into the duodenum (6, 10).
Antral motility is also assessed optimally after ingestion of
a solid meal. As would be expected from the experimental
conditions in our study there were relatively few antral
pressure waves.
The observation of a pyloric response to the presence of
nutrients in the duodenum suggests that small intestinal
feedback mechanisms are intact (1, 16, 17, 32). It is not
surprising that the intraduodenal triglyceride infusion did
not further stimulate phasic pyloric motility as the rate of
caloric delivery was at the lower end of the normal physi-
ological range and the infusion was initiated after ingestion
of a nutrient liquid meal, which is a stimulus of both phasic
and tonic pyloric motility (2, 31). Because the increase in
basal pyloric pressure was dynamic, in that it was ⬍2 mm
Hg for about 40% of the time after ingestion of the drink,
emptying could still occur (19).
Pyloromyotomy had no effect on overall patterns of gas-
tric emptying or intragastric distribution of the drink in
either the sitting or left lateral position. The only difference
observed was that intraduodenal lipid did not slow gastric
emptying in the pyloromyotomy group in the lateral position
and, in this position, the amount emptied during the in-
traduodenal lipid infusion was greater than in the control
subjects. This observation may suggest that after pyloro-
myotomy for IHPS there are subtle abnormalities in the
small intestinal feedback regulation of gastric emptying, but
further studies are required to address this issue, particularly
as there were no differences in the effects of intraduodenal
lipid on gastric emptying between the pyloromyotomy and
control groups in the sitting position. All previous studies of
gastric emptying after pyloromyotomy for IHPS, using ul-
trasound or scintigraphic techniques, have been performed
with the subject in the supine or semirecumbent position
(20 –23); in all but one study (33) gastric emptying was
normal. In the latter study gastric emptying was reported to
be accelerated after pyloromyotomy, but a suboptimal, dou-
ble sampling technique was used (33). It should also be
recognized that gastric emptying is predominantly pulsatile,
Effects of Pyloromyotomy on Pyloric Motility 99
rather than continuous (34) and we cannot exclude the
possibility that the volume or duration of individual flow
pulses was modified by pyloromyotomy (11, 25).
ACKNOWLEDGMENTS
This study was supported by the National Health and Med-
ical Research Council of Australia. The authors thank Sue
Suter for typing this manuscript and Ms. K. Willson (bio-
statistician) for assistance with the statistical analysis.
Reprint requests and correspondence: M. Horowitz, M.B.B.S.,
Ph.D., Department of Medicine, Royal Adelaide Hospital, North
Terrace, Adelaide, South Australia, Australia, 5000.
Received May 13, 1999; accepted Sep. 23, 1999.
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