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Ghrelin was first discovered as a peptide involved in growth hormone release, but has now emerged as a new player in the regulation of gastrointestinal function. Ghrelin is structurally and functionally related to motilin. Like motilin, it induces a specific motor pattern in the fasted state and acts postprandially to accelerate gastric emptying. There is no apparent cross-reactivity with motilin at the receptor level. Ghrelin agonists have the same potential as motilin agonists, and applications in post-operative ileus and gastroparesis have already been explored. Although promising, there is still the need to avoid side effects and the problems encountered with motilides. This will require drugs with an appropriate pharmacokinetic profile. In addition, the dosage regimen and target population should be carefully taken into consideration when planning clinical trials.