Pathophysiological responses to meals in the Zollinger-Ellison syndrome: 2. Gastric emptying and its effect on duodenal function.

In this study, we investigated the relationship between gastric emptying and duodenal events in patients with the Zollinger-Ellison syndrome due to a gastrinoma. Like the inhibitory effect of a meal on gastric secretion (described in a companion paper), postprandial inhibition of gastric emptying reduces fractional gastric emptying rates to normal during the first two hours after a meal. Gastric discharges of content into the duodenum fluctuate considerably, and, in some patients, duodenal acid load and neutralising duodenal secretions appear to be incoordinated. These mechanisms interact in part as a protective system that maintains reasonably normal duodenal homeostasis in most Zollinger-Ellison patients during the early postprandial period. Our data may explain why clinical evidence of overt-malabsorption is less prevalent and severe in these patients than would be expected from their enormously increased fasting gastric secretory outputs.