GASTRIC AND SMALL INTESTINAL MOTILITY IN HEALTH AND DISEASE
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
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2015, Computers in Biology and MedicineCitation 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.
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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
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From the University of Nebraska Medical Center, Omaha, Nebraska