GASTRIC AND SMALL INTESTINAL MOTILITY IN HEALTH AND DISEASE

https://doi.org/10.1016/S0889-8553(05)70368-XGet rights and content

Section snippets

BASIC PHYSIOLOGY

The main functions of gastric motility are to accommodate and store the ingested meal, grind down or triturate solid particles, and then empty the meal in a regulated fashion into the duodenum. Small intestinal motility should serve to mix the meal with intestinal secretions and propel digesta in an aborad direction when appropriate. Specialized muscles at the lower esophageal, pyloric, and ileocecal sphincters regulate transit across these regions and prevent orad reflux.

Contractile activity

REGULATION OF GASTRIC AND SMALL INTESTINAL MOTILITY

Several factors related to the meal ingested influence its emptying rate (Table 1) In the small intestine, the generation and propagation of the MMC appears to be independent of extrinsic nerves and is intrinsic to the gut itself. The ability to switch from the fasted to the fed state depends on extrinsic nerves and the vagus in particular. Although the integration of gastric events with the MMC remains incompletely understood, it appears that both extrinsic w2nerves (especially the vagus) and

Scintigraphic Assessment of Gastric Emptying

Scintigraphic techniques have almost entirely replaced perfusion methods and have become the mainstay of the assessment of gastric function in clinical practice. 28, 43, 87, 95, 101 Various meals and isotopes are used, the important principle being that the isotope should remain totally bound with the meal during emptying; for a solid marker, the isotope should not leech into the liquid phase. Similarly a liquid marker should not be adsorbed onto the solid phase. To achieve standardized

Gastric Motor Dysfunction

Given that the primary motor function of the stomach is to generate emptying, its motor disorders have traditionally been classified according to their effects on emptying, 22, 23, 95 with gastroparesis, or delayed emptying, representing the more common clinical entity (Table 3)Symptoms typically associated with gastroparesis include postprandial fullness, bloating, distention, nausea, and vomiting. These symptoms are, however, notoriously nonspecific and are poorly predictive of gastric motor

SUMMARY

Although symptoms possibly related to motor dysfunction appear to be common, primary disorders of the foregut motor apparatus, defined on the basis of a discrete myoneural pathology, are notably rare. This phenomenon may as much reflect the relatively primitive nature of diagnostic methods as the true rarity of such disorders. Although diagnostic methodologies increase in sophistication and availability, their clinical impact has been limited by an imperfect relationship between symptoms and

First page preview

First page preview
Click to open first page preview

References (165)

  • L.J. Colemont et al.

    Chronic intestinal pseudo-obstruction: Diagnosis and treatment

    Mayo Clin Proc

    (1989)
  • F.L. Datz et al.

    Physiological and pharmacological interventions in radionuclide imaging of the tubular gastrointestinal tract

    Semin Nucl Med

    (1991)
  • A. Dubois et al.

    Altered gastric emptying and secretion in primary anorexia nervosa

    Gastroenterology

    (1979)
  • M.P. Greydanus et al.

    Abnormal postcibal antral and small bowel motility due to neuropathy or myopathy in systemic sclerosis

    Gastroenterology

    (1989)
  • M.P. Greydanus et al.

    Ileocolonic transfer of solid chyme in small intestinal neuropathies and myopathies

    Gastroenterology

    (1990)
  • T. Hausken et al.

    Antroduodenal motility studied by real-time ultrasound

    Gastroenterology

    (1991)
  • J.E. Kellow et al.

    Sulfapyridine appearance in plasma after salicylazo sulfapyridine: Another simple measure of intestinal transit

    Gastroenterology

    (1986)
  • J.E. Kellow et al.

    Human interdigestive motility: Variations in patterns from esophagus to colon

    Gastroenterology

    (1986)
  • J.E. Kellow et al.

    Prolonged ambulant recordings of small bowel motility demonstrate abnormalities in the irritable bowel syndrome

    Gastroenterology

    (1990)
  • J.E. Kellow et al.

    Altered small bowel motility in irritable bowel syndrome is correlated with symptoms

    Gastroenterology

    (1987)
  • D.D. Kerrigan et al.

    Disturbed gastroduodenal motility in patients with active and healed duodenal ulceration

    Gastroenterology

    (1991)
  • S. Krishnamurthy et al.

    Chronic intestinal pseudo-obstruction in infants and children caused by diverse abnormalities of the myenteric plexus

    Gastro-enterology

    (1993)
  • S. Krishnamurthy et al.

    Jejunal diverticulosis: A heterogenous disorder caused by a variety of abnormalities of smooth muscle or myenteric plexus

    Gastroenterology

    (1983)
  • S. Krishnamurthy et al.

    Pathology of neuromuscular disorders of the small intestine and colon

    Gastroenterology

    (1987)
  • D. Kumar et al.

    The irritable bowel syndrome: A paroxysmal motor disorder

    Lancet

    (1985)
  • G. Labò et al.

    Interdigestive gastroduodenal motility and serum motilin levels in patients with idiopathic delay in gastric emptying

    Gastroenterology

    (1986)
  • J.-R. Malagelada

    Diabetic gastroparesis in perspective

    Gastroenterology

    (1994)
  • J.-R. Malagelada et al.

    Manometric evaluation of functional upper gut symptoms

    Gastroenterology

    (1985)
  • L.S. Malmud et al.

    Scintigraphic evaluation of gastric emptying

    Semin Nucl Med

    (1982)
  • J.R. Mathias et al.

    Nausea, vomiting and abdominal pain after Roux-en-Y anastomosis: Motility of the jejunal limb

    Gastroenterology

    (1985)
  • F. Mearin et al.

    Pyloric dysfunction in diabetics with recurrent nausea and vomiting

    Gastroenterology

    (1986)
  • B.W. Miedema et al.

    Human gastric and jejunal transit and motility after roux gastrojejunostomy

    Gastroenterology

    (1992)
  • M.P. Mintchev et al.

    Accuracy of cutaneous recordings of gastric electrical activity

    Gastroenterology

    (1993)
  • M.D. O'Brien et al.

    The rumination syndrome: Clinical features rather than manometric diagnosis

    Gastroenterology

    (1995)
  • J.J. Oh et al.

    Gastroparesis after a presumed viral illness: Clinical and laboratory features and natural history

    Mayo Clin Proc

    (1990)
  • T.L. Abell et al.

    Interoperative electrophysiology and full-thickness biopsy provide useful diagnostic information in patients with refractory nausea and vomiting

    Gastroenterology

    (1994)
  • R.P. Amarnath et al.

    The rumination syndrome in adults

    Ann Intern Med

    (1986)
  • J.L. Barnett et al.

    Campylobacter pylori is not associated with gastroparesis

    Dig Dis Sci

    (1989)
  • A.E. Bharucha et al.

    Autonomic dysfunction in gastrointestinal motility disorders

    Gut

    (1993)
  • S. Bollinger et al.

    Disordered gastrointestinal motility

  • M. Bortolotti et al.

    Brainstem viral-like encephalitis as a possible cause of a gastroduodenal motility disorder: A case report

    J Gastrointest Motil

    (1989)
  • M. Camilleri

    Jejunal manometry in distal subacute mechanical obstruction: Significance of prolonged simultaneous contractions

    Gut

    (1989)
  • M. Camilleri et al.

    Abnormal intestinal motility in diabetics with the gastroparesis syndrome

    Eur J Clin Invest

    (1984)
  • M. Camilleri et al.

    Gastrointestinal motility disturbances in patients with orthostatic hypotension

    Gastroenterology

    (1985)
  • M. Camilleri et al.

    Motility disorders and stress

    Dig Dis Sci

    (1989)
  • M. Camilleri et al.

    Towards a less costly but accurate test of gastric emptying and small bowel transit

    Dig Dis Sci

    (1991)
  • T.K. Chaudhuri et al.

    Update: Pharamaceuticals and gastric emptying

    Am J Gastroenterol

    (1990)
  • T.K. Chaudhuri et al.

    Gastric emptying in human disease states

    Am J Gastroenterol

    (1991)
  • J.D.Z. Chen et al.

    Clinical applications of electrogastrography

    Am J Gastroenterol

    (1993)
  • J. Christensen et al.

    Pseudo-obstruction: Working team report

    Gastroenterol Int

    (1990)
  • Cited by (97)

    • Small intestinal motility disorders

      2019, Clinical and Basic Neurogastroenterology and Motility
    • Motility bar: A new tool for motility analysis of endoluminal videos

      2015, Computers in Biology and Medicine
      Citation Excerpt :

      The precise role of these contractions in the digestion process has not yet been established [3]. Currently, the main source of information, which leads to a diagnosis of small intestine motility disorders, is manometry [4,5]. However, this technique has three shortcuts: (1) it is highly invasive, causing patient discomfort; (2) it does not provide the visualization of the intestine; and (3) only a part of the organ can be evaluated.

    • Adaptable image cuts for motility inspection using WCE

      2013, Computerized Medical Imaging and Graphics
    • Gastroparesis and Parkinson's disease: A systematic review

      2012, Parkinsonism and Related Disorders
    • Bagged one-class classifiers in the presence of outliers

      2013, International Journal of Pattern Recognition and Artificial Intelligence
    View all citing articles on Scopus

    Address reprint requests to Eamonn M. M. Quigley, MD, FRCP (Glasg, Edin), Section of Gastroenterology and Hepatology, University of Nebraska Medical Center, 600 South 42nd Street, Omaha, NE 68198-2000

    *

    From the University of Nebraska Medical Center, Omaha, Nebraska

    View full text