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, …