Fifteen years ago it was believed that motility studies would become to functional symptoms what endoscopy was (and still is) to ulcers, gallstones and cancer. Today, the ratio of endoscopic examinations to motility studies in most district general hospitals remains hundreds to one. There is no shortage of patients (about half the new referrals to gastroenterology outpatients are for functional symptoms), just no tests with which to make a positive diagnosis. The study by Wilmer et al from Leuven in Belgium illustrates why the early expectations of motility studies have not been realised (see page 235).

The starting point for the study was the belief that disturbed upper gut motility is responsible for functional dyspeptic symptoms. Others have shown that dyspeptic patients have abnormal motility.1 This study hoped to go one step further and link symptoms with specific patterns of dysmotility by using prolonged ambulatory motility studies. The logical extension of finding such a link is that the test …