GASTRIC MOTILITY. HYPOTESIS
Abstract
The publication is based on a retrospective analysis of 344 radiological studies of the upper digestive tract and analysis of the literature. We propose the hypothesis of the gastric motility, based on the following points: 1) The gastric cardia is the intra-abdominal portion of the lower esophageal sphincter (LES). Its tone increases in response to the increasing pressure in the stomach. 2) In gastroesophageal reflux disease (GERD), the cardia cannot withstand the pressure and subsequently opens. Depending on the degree of insufficiency of the LES and the force applied during provocative test, angular deformity of the stomach appears, due to the shortening of LES as well as a downsizing of the gas bubble in the stomach; 3) Pyloric sphincter (PS) is a true sphincter. Evacuation from the stomach is the result of the opening of the PS due to increase of antral pressure above the "threshold" level; 4) The evacuation starts in the upright position, when the liquid chyme above PS creates hydrostatic pressure above the threshold; 5) When hydrostatic pressure is reduced below the threshold level or in the recumbent position the antral pressure is created by the clamping of deep peristaltic wave and formation of the closed antral cavity; 6) The portioned evacuation is provided in two ways; а) the volume of antral cavity corresponds to the volume of duodenal bulb; b) in upright position after filling of the duodenal bulb the postbulbar sphincter is closed, whereby the pressure in the bulb rises, which leads to a reflex contraction of the PS and cessation of the e stomach emptying.
About the Authors
M. D. Levin
State Geriatric Center
Russian Federation
Russian Federation
Z. .. Korshun
State Geriatric Center
Russian Federation
Russian Federation
G. .. Mendelson
State Geriatric Center
Russian Federation
Russian Federation
References
1. Törnblom H, Simrén M, Abrahamsson H. Gastrointestinal motility and neurogastroenterology. Scand J Gastroenterol. 2015 Jun;50(6):685-97.
2. Patrick A, Epstein O. See comment in PubMed Commons below Review article: gastroparesis. Aliment Pharmacol Ther. 2008 May;27(9):724-40.
3. Гистология (перевод с анг.). - Хэм А, Кормак Д. -1983. - Т. 4. - С. 127.
4. Ahluwalia NK, Thompson DG, BarlowJ. Effect of distension and feeding on phasic changes in human proximal gastric tone. Gut 1996; 39: 757-61.
5. Shafik A, Shafik AA, El Sibai O, Shafik IA. The effect of gastric overfilling on the pharyngo-esophageal and lower esophageal sphincter: a possible factor in restricting food intake. Med Sci Monit. 2007 Oct;13(10): BR220-4.
6. Shafik A, El Sibai O, Shafik A. Study of the duodenal contractile activity during antral contractions. World J Gastroenterol. 2007 May 14;13(18):2600-3.
7. Shafik A. Effect of duodenal distension on the pyloric sphincter and antrum and the gastric corpus: duodenopyloric reflex.World J Surg. 1998 Oct;22(10):1061-4.
8. Hanani M. Interstitial cells of Cajal - the pecemaker of the gastrointestinal system. Harefuah. 1999; 136(4):307-12.
9. Левин МД, Коршун З, Мендельсон Г. Патологическая физиология гастроэзофагеальной рефлюксной болезни. Гипотеза. Эксп Клин Гастроэнтерол. 2013;(5):72-88.
10. Tolone S, de Cassan C, de Bortoli N, et al. Esophagogastric junction morphology is associated with a positive impedance-pH monitoring in patients with GERD. Neurogastroenterol Motil. 2015 May 25. doi: 10.1111/nmo.12606. [Epub ahead of print]
11. Yoo SS, Lee WH, Ha J, Choi SP, Kim HJ, Kim TH, Lee OJ. The prevalence of esophageal disorders in the subjects examined for health screening. Korean J Gastroenterol. 2007 Nov;50(5):306-12.
12. Stål P, Lindberg G, Ost A, Iwarzon M, Seensalu R. Gastroesophageal reflux in healthy subjects. Significance of endoscopic findings, histology, age, and sex. Scand J Gastroenterol. 1999 Feb;34(2):121-8.
13. Chandrasoma P, Wijetunge S, Ma Y, Demeester S, Hagen J, Demeester T. The dilated distal esophagus: a new entity that is the pathologic basis of early gastroesophageal reflux disease. Am J Surg Pathol. 2011 Dec;35(12):1873-81.
14. Ackermann C., Rothenbhler J.M., Martinoli S., Muller C. Esophagealmanometry prior to and following anti-reflux surgery. Schweiz. Med. Wochenschr.1991; 121 (21): 797-800.
15. Liebermann-Meffert D., Allgwer M., Schmid P., Blum A. L. Muscular equivalent of the lower esophageal sphincter. Gastroenterology. 1979 Jan;76(1):31-8.
16. Shaker R1, Dodds WJ, Kahrilas PJ, et al. Relationship of intraluminal pH and pressure within the lower esophageal sphincter. Am J Gastroenterol. 1991 Jul;86(7):812-6.
17. Peng L, Patel A, Kushnir V, Gyawali CP. Assessment of Upper Esophageal Sphincter Function onHigh-resolution Manometry: Identification of Predictors of Globus Symptoms. J Clin Gastroenterol. 2014 Jan 31. [Epub ahead of print].
18. Vegesna AK1, Sloan JA, Singh B, et al. Characterization of the distal esophagus high-pressure zone with manometry, ultrasound and micro-computed tomography. Neurogastroenterol Motil. 2013 Jan;25(1):53-60.e6. doi: 10.1111/nmo.12010. Epub 2012 Sep 24.
19. Левин МД, Троян ВВ. Анатомия и физиология аноректальной зоны. Гипотеза удержания кала и дефекации. Новости хирургии. 2009; 17(2): 105-18.
20. Богач ПГ. Пищеварение в полости желудка// В кн. Физиология человека. 1976- Л.: Наука. - с. 277-309.
21. Keller Y, Waldman D, Greiner P. Comparison of preoperative sonography with intraoperative findings in congenital hypertrophic pyloric stenosis. J Pediatr Surg. 1987 Oct;22(10):950-2.
22. Keet AD, Heydenrich JJ. The anatomy and movement of the pyloric sphincteric cylinder. S Afr Med J. 1982 Jul 3;62(1):15-8.
23. Schulze-Delrieu K, Shiarazi SS. Neuromuscular differentiation of the human pylorus. Gastroenterology. 1983 Feb;84(2):287-92.
24. Физиология пищеварения / Руководство по физиологии/ Под редакцией ВН. Черниговского. - Л: Наука, 1974. -761с.
25. Scientific basis of gastroenyerology. Ed. By HL.Duthic, Wormaley. Churchill: Livingston et al., 1979. - 498 p.
26. Левин МД, Фидельман З, Троян ВВ. Двигательная функция желудка и двенадцатиперстной кишки в рентгенологическом изображении (гипотеза). Медицина. 2008. - № 2. - с. 7-11.
27. Anatomy of the human body. By Henry Gray/ Philadelphia: Lea and Febiger, 1918 New York: Bartleby. Com/2000.
28. Сакс ФФ, Задорожный АА, Ефимов НП, Байтингер ИФ. Хирургическая анатомия гастродуоденального перехода. Вестн хир им ИИ.Грекова. - 1987. - Т. 139. -№ 11. - С. 41-45.
Review
For citations:
Levin M.D., Korshun Z..., Mendelson G... GASTRIC MOTILITY. HYPOTESIS. Experimental and Clinical Gastroenterology. 2016;(10):104-112. (In Russ.)
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