A 32-Year-Old Man Is Evaluated for Recurrent Nausea and Vomiting

A 32-year-old man is evaluated for recurrent nausea and vomiting.  The patient has nausea and upper abdominal discomfort after meals and feels full even after eating a small amount of food.  He also has experienced several episodes of vomiting of undigested food particles but has had no fever or diarrhea.  The patient has a history of type 1 diabetes mellitus and diabetic neuropathy.  Physical examination shows a clear oropharynx.  The abdomen is soft, nondistended, and nontender with no organomegaly.  Bowel sounds are normoactive.  Stool testing for occult blood is negative.  Upper gastrointestinal endoscopy reveals no abnormalities.  Treatment with an oral medication is initiated, but it is stopped after the patient experiences abnormal involuntary movements.  A macrolide antibiotic is prescribed, which improves his symptoms.  Which of following mechanisms is most likely responsible for the improvement in this patient's symptoms?

A) Agonistic activity on motilin receptors
B) Blockade of gastrointestinal muscarinic receptors
C) Increase in intestinal fluid secretion
D) Protective effect on gastric mucosa
E) Suppression of intestinal bacterial growth

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