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TO THE EDITOR: We appreciate sincerely the interest and comments of Dr. Tomita and Dr. Miwa1 on our paper on the "Effects of histamine-2 receptor antagonists and proton pump inhibitors on the rate of gastric emptying: a crossover study using a continuous real-time 13C Breath Test (BreathID System)."2 As they pointed out, many studies have been conducted to exam the effects of gastric acid suppressants on gastric emptying, however, results from those studies have been controversial. Our study using liquid meals revealed that intravenous administration of gastric acid suppressants had no significant influence on the rate of gastric emptying. Indeed, the examination using solid meals might be more useful for the clinical setting. But in previous studies using solid meals, conflicting results were reported.3-5 We speculate that various mechanisms induced by gastric acid suppressants, such as reduction of duodenal break, modification of volume and energy density of intragastric contents, delay in hydrolyzing and elevation of serum gastrin levels, might influence the rate of gastric emptying and interact respectively in a complicated manner.  We quite agree with Dr. Tomita and Dr. Miwa that more investigations regarding whether gastric acid suppressants enhance the gastric accommodation should be performed. This clinical implication is very interesting, because not only delayed gastric emptying but also defective gastric accommodation is considered as important pathogenesis of functional dyspepsia. Unfortunately, this hypothetical mechanisms induced by gastric acid suppressants, especially proton pump inhibitors, have never been investigated thoroughly.6 If gastric acid suppressants enhanced the gastric accommodation, the rate of gastric emptying would decelerate clearly. In our study, there were no significant differences in any of the parameters of gastric emptying measured with using the BreathID system among a single intravenous administration of famotidine, omeprazole and saline alone. Further investigation on the effects of gastric acid suppressants on the gastrointestinal motility should be conducted.  We again thank Dr. Tomita and Dr. Miwa for bringing some of their insightful thoughts on our paper.

Do Histamine-2 Receptor Antagonists and Proton Pump Inhibitors Really Have No Effect on the Gastric Emptying Rate?: Author's Reply