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We enjoyed reading the provocative commentary by Camilleri (Gut 2006;55:909–10) on our large study of patients with functional dyspepsia (Gut 2006;55:933–9). We completely agree that delayed gastric emptying is a marker of disturbed pathophysiology in functional dyspepsia; indeed, we first reported this observation in 1989.1 However, we remain unconvinced, based on the available data, that this abnormality alone is linked to upper gastrointestinal symptoms.1–3 Factor analysis studies from the general population, in the absence of objective testing, do not provide insights into this issue,4,5 although we have shown that non-consulters with dysmotility-like dyspepsia are more likely to have gastric emptying delay.6 Studies from selected tertiary care patients are of interest, but Camilleri has previously reported negative results.3 Importantly, in a previous study of 551 patients with functional dyspepsia and 247 patients with type I diabetes and postprandial dyspepsia, gastric emptying, as measured by C13 octanoic acid breath testing, was …
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