GASTRIC MOTILITY & GASTRIC

EMPTYING
DR.ABHINAV KUMAR
Moderator : Dr.Lokesh LV
The stomach can be divided into three anatomic (A)
and two functional regions (B)

A B
Fundus
Pylorus

Antrum Gastric pump Gastric reservoir

Corpus Phasic contractions Tonic contractions
 The relaxation of the gastric reservoir is mainly regulated
by reflexes. Three kinds of relaxation can be differentiated:
the receptive, adaptive and feedback-relaxation

1. Receptive
Mechanical relaxation Vagus
stimuli in the centre
pharynx Inhibitory
vagal fibre
3. Feedback 2. Adap tive (NANC-inhibition)
relaxation relax ation ACH
CCK NO + VIP et al.
Tension Relaxation of
Nutrients Nutrients
receptors gastric reservoir
Distension
The transport of digestive from the gastric reservoir
into the antral pump is caused by two mechanisms:
tonic contractions and peristaltic waves in the region
of the gastric corpus
Tonic
contraction

Pylorus

Accumulation Peristaltic wave

Proximal of chyme (Pump of the reservoir)
antrum
Backflow from antrum and flow from reservoir
 The function of the gastric pump can be differentiated into
three phases: A: phase of propulsion, B: phase of emptying,
C: phase of retropulsion and grinding
Phases A Phase of propulsion
ABC Contraction of proximal antrum (PA)
Pylorus

Proximal Propulsion of chyme into relaxing

antrum terminal antrum
+ duodenal contraction
PA
Middle B Phase of emptying
antrum
Contraction of middle antrum (MA)
Terminal
antrum MA Transpyloric and retrograde flow
closed + duodenal relaxation
Pylorus
open TA
C Phase of retropulsion
Contraction of terminal antrum (TA)
Duodenum
Jet-like back-flow with grinding
10 sec + duodenal contraction
 Liquids and small particles leave the stomach
more rapidly than large particles.
This discrimination is called „sieving function“
Phase of propulsion Phase of emptying Phase of retropulsion

Antrum

Bulge

Rapid flow of liquids with Emptying of liquids with Retropulsion of large

suspended small particles small particles whereas particles and clearing
and delayed flow of large large particles are retained of the terminal antrum
particles towards pylorus in the buldge of the terminal
antrum
 Grinding of solid particles is caused by a forceful
jet-like retropulsion through the small orifice of the
terminal antral contraction

Onset Late phase

of terminal antral of terminal antral
contraction contraction

Pylorus closing Pylorus closed

 Antro-duodenal co-ordination: Contractions of the proximal
duodenum cease during the phases of gastric emptying..
Phases of gastric emptying

Middle antrum

Terminal
antrum Antral
closed waves
Pylorus
open
9.9 3.5 6.6 3.5 9.9 sec

Proximal
duodenum 1 2 3 1 2 3 1 2 3 4 1

Lacking duodenal contractions

0 5 10 15 20 25 30 35 sec
Because of different frequencies between antral and duodenal contractions,
the duodenum can contract three to four times during an antral wave
 Several factors of gastric and duodenal motility
co-operate and modulate gastric emptying:
A. Rapid emptying B. Delayed emptying

Pylorus
1a 6a
4 3 9 8

10 6b
5 1b
2 7

A. Rapid emptying is caused by tonic contractions of the reservoir (1a), deep

peristaltic waves along the gastric body (1b), deep constrictions of the antral
waves (2), a wide opening of the pylorus (3), a duodenal receptive relaxation (4)
and peristaltic duodenal contractions (5).
B. Delayed emptying due to feedback inhibition is caused by a prolonged
relaxation of the reservoir (6a), shallow peristaltic waves along the gastric body
( 6b), shallow antral waves (7), a small pyloric opening (8), a lacking duodenal
relaxation (9) and segmenting duodenal contractions (10).
Balance between gastric reservoir and antral pump

Gastro-gastric reflexes
Enhanced and prolonged
relaxation of reservoir

Inhibitory
reflex Distension
Disten-
sion

Antral pump
switched on Excitatory
and intensified reflex
 Pyloric activity is modulated by antral inhibitory
and duodenal excitatory reflexes

Descending
inhibitory reflex
causing
pyloric relaxation

Ascending
excitatory reflex
causing
pyloric contractions
and increasing
pyloric tone
Contraction of
Duodenal stimuli middle antrum
 An additional function of the pyloric sphincter
is to prevent duodeno-gastric reflux

Antrum Pyloric closure

closed

Pylorus
open
Inhibition
Duod. bulb

Duodenum Stimulation

0.5 ml oleic acid + bile

into duodenum
Duodenal stimuli like oleic acid inhibit antral contractions, evoke duodenal
contractions, increase pyloric tone and elicit frequent pyloric contractions
Solids and liquids of the gastric chyme are emptied with
different velocities.
Lag phase

100
Solids
80
Viscous
60 content

40
Liquid
20 content

0
0 20 40 60 80 100 120
Time (min)

Emptying of liquids is exponential, emptying of large solid particles only

begins after sufficient grinding (lag phase). Afterwards the viscous chyme
is mainly emptied in a linear fashion
 The feedback regulation of gastric emptying is performed
by entero-gastric reflexes and release of intestinal hormones
Vagal
center
+
Nutrients _
+ Inhibitory
Long chain fatty acids
Amino acids vagal fibers
Dipeptids Stimulating cholinergic
ACH
Glucose vagal fibers
Osmolality NO, VIP et al.
Hydrochloric acid CCK
Enhanced
ACH
relaxation
and
Reduced opening storage
of pyloric sphincter Backflow
Reduced
contraction

It causes enhanced relaxation of the gastric reservoir, inhibition of the antral

pump, and reduced opening of the pyloric sphincter.
 Regulation of Stomach Emptying
(Summary)
1. Gastric Factors That Promote Emptying
– Food Volume: Increased food volume in the stomach
promotes emptying from the stomach (inhibits the pylorus).
– Gastrin hormone: enhances the activity of the pyloric pump.

2. Powerful Duodenal Factors That Inhibit Stomach Emptying

• At the presence of food in the duodenum, multiple nervous
reflexes are initiated from the duodenal wall that pass back to
the stomach to slow or even stop stomach emptying via one of
the following routes:(1) directly through ENS, (2) through
extrinsic nerves that go to the prevertebral sympathetic
ganglia and then back through inhibitory sympathetic nerve
fibers to the stomach, and (3) through the vagus nerves.
 Regulation of Stomach Emptying
Summary
The types of factors that can initiate enterogastric inhibitory reflexes
include the following:

1. The distention of the duodenum.

2. Acidity of the duodenum activates S cells to release Secretin

which constricts the antrum

3. Fat (monoglycerides) in the duodenum activates different cells to

produce CCK and GIP that delay gastric emptying

4. Hyperosmotic or hyposmotic solutions delay gastric emptying

5. Amino acids elicit inhibitory enterogastric reflexes; by slowing the

rate of stomach emptying.
 Summary
Constriction of Pyloric Sphincter

• Hormones promote constriction

1. Cholecystokinin (CCK)
2. Secretin
3. Glucose-dependent insulinotropic peptide (GIP)
• Sympathetic innervation