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Determinants of gastric emptying and transit in the small intestine

Juan‐R. Malagelada, Fernando Azpiroz

10.1002/cphy.cp060123

Source: Supplement 16: Handbook of Physiology, The Gastrointestinal System, Motility and Circulation

Originally published: 1989

Published online: January 2011

Full Article on Wiley Online Library



Abstract

The sections in this article are:

1 Functional Division of Stomach
1.1 Methodological Aspects: Interrelationships Among Parietal Force and Manometric and Electrical Measurements of Gastric Motility
2 Gastrointestinal Motility During Interdigestive Period
2.1 Interdigestive Motor Pattern of Stomach
2.2 Interrelationships Between Gastric Motility, Secretion, and Clearance of Duodenogastric Reflux During Interdigestive Period
3 Gastrointestinal Response to A Meal
3.1 Swallowing
3.2 Early Postcibal Period
3.3 Plateau Phase
3.4 Declining Phase and Transition to Interdigestive Activity
4 Gastric Emptying Profile
5 Relationships among Gastric Emptying, Motility, and Structure: Mechanics of Gastric Emptying
5.1 Preliminary Processing: Antropyloric Grinder
5.2 Emptying Function
6 Effects of Gravity and Body Position on Gastric Emptying
7 Regulation of Gastric Emptying
7.1 Physical and Chemical Characteristics of Meals That Influence their Emptying From Stomach
7.2 Interactions Between Gastric Emptying and Gastric Secretion
8 Intestinal Motility and its Relationship to Luminal Flow and Absorption
9 Physiological Measurement of Transit In Small Bowel
10 Effect of Opiates and Sex Hormones on Intestinal Motility and Transit
11 Control of Gastrointestinal Motility: Physiological and Pathophysiological Implications for Gastric Motility and Intestinal Transit
11.1 Control at Level of Gut Smooth Muscle
11.2 Control at Level of Gut Intrinsic and Extrinsic Nervous Systems
11.3 Hormonal Control
11.4 Control at Cerebral Level
Figure 1. Figure 1.

Functional division of stomach as it relates to motor and secretory function.
Figure 2. Figure 2.

Canine gastrointestinal pressure activity during fasting recorded at paper speed of 10 mm/min. Note 2 interdigestive migrating motor complexes, with participation of both proximal and distal stomach.

From Azpiroz and Malagelada 20
Figure 3. Figure 3.

Phasic pressure patterns in proximal stomach, distal stomach, and proximal duodenum during a period of motor activity. Note broad‐base fundic pressure waves that propagate into distal stomach and gradually transform themselves into peaked antral waves. Antral waves that are coordinated with fundic waves are of higher amplitude than those interposed. Antral waves coordinated with fundic waves are also associated with quiescence in duodenum (noticeable during periods of duodenal regular motor activity).
Figure 4. Figure 4.

Canine gastrointestinal pressure activity during fasting: lower esophageal sphincter (LES) pressure recording during period of activity in fundus at paper speed of 25 mm/min. Note relationship of fundic pressure waves with LES pressure and antral activity and with transient decrease of duodenal phase III activity. Fundic waves occur at rhythm of 25% to 20% of antral frequency. See Figure 3 for representation of this phenomenon.

From Azpiroz and Malagelada 20
Figure 5. Figure 5.

Canine postcibal gastrointestinal motor activity recorded at paper speed of 10 mm/min. Barostat recorded pressure and volume of air within intragastric bag. Note postcibal volume initially remains at relatively low levels. However, later it increases gradually, reaching level higher than fasting level.

From Azpiroz and Malagelada 21
Figure 6. Figure 6.

Dynamics of gastric emptying. Data correspond to an idealized solid and liquid meal of ∼400 ml total volume, with a liquid‐to‐solid ratio of 1:1 (based on data from refs. 151–154 and J.‐R. Malagelada, unpublished observations).
Figure 7. Figure 7.

Antropyloric propulsion/retropulsion mechanism. See text for full description.
Figure 8. Figure 8.

Gastric accommodation and gastric emptying. Gastric accommodation (left) is primarily a function of proximal stomach. Gastric emptying (right) depends on coordinated action of proximal stomach, increasing intragastric pressure, and distal antrum, pylorus, and duodenum, acting to vary resistance.
Figure 9. Figure 9.

Effect of pylorus on gastric outflow in in vitro preparation from cat. Stomach was filled with saline solution. A: with draining cannula placed in duodenum, gastric output ceased and resumed multiple times, showing that pylorus imparts a pulsatile character to gastric outflow. B: when draining cannula was placed in the antrum itself, output ceased completely after short period.

From Schulze‐Delrieu and Brown 230
Figure 10. Figure 10.

Mean rates of gastric emptying (A, in ml/min; B, in kcal/min) for 18 combinations of volume and caloric density of meal fed to healthy volunteers. Rates calculated as linear slope from regression of energy delivered vs. time for all individual subjects, for each combination of meal volume and energy density. Means are plotted: ▴, 300‐ml meals; ▪, 400‐ml meals; and •, 600‐ml meals. Solid lines (B), linear regressions of mean caloric rate vs. energy density for each of three volumes; slopes of these lines are not significantly different.

From Hunt et al. 110
Figure 11. Figure 11.

Comparison of emptying of spheres with emptying of liver and of filter paper squares in dog. Slope ratios are plotted on ordinate as function of sphere diameter on abscissa. Points are means ± SE. Numbers in parentheses are numbers of repeated experiments in each group of dogs. Open circles and dashed line, spheres with density of 1; solid circles and solid line, spheres with density of 2. Cross, slope ratio for filter paper squares. Asterisks, significant differences from 1.0, i.e., from equal rates of emptying of spheres and liver.

From Meyer et al. 171
Figure 12. Figure 12.

Comparison of 50% gastric emptying and median small bowel transit for liquid and solid components of chyme for each of 6 healthy volunteers studied with a radioscintigraphic technique. Note that physical properties of food appear to have different influences on gastric emptying and intestinal transit: stomach selectively retains meal solids, but small bowel does not discriminate between solids and liquids. NS, not significant. DTPA, diethylenetriamine pentaacetic acid.

From Malagelada et al. 156
Figure 13. Figure 13.

Subjective scores for epigastric fullness during ingestion of meal and simultaneous infusion of either lipid emulsion (solid line) or saline control (dotted line) into ileum. Note earlier epigastric fullness with perfusion of ileal fat that delays gastric emptying (asterisk). Data are shown as means ± SE for 6 healthy volunteers; P < 0.05.

From Welch et al. 272


Figure 1.

Functional division of stomach as it relates to motor and secretory function.



Figure 2.

Canine gastrointestinal pressure activity during fasting recorded at paper speed of 10 mm/min. Note 2 interdigestive migrating motor complexes, with participation of both proximal and distal stomach.

From Azpiroz and Malagelada 20


Figure 3.

Phasic pressure patterns in proximal stomach, distal stomach, and proximal duodenum during a period of motor activity. Note broad‐base fundic pressure waves that propagate into distal stomach and gradually transform themselves into peaked antral waves. Antral waves that are coordinated with fundic waves are of higher amplitude than those interposed. Antral waves coordinated with fundic waves are also associated with quiescence in duodenum (noticeable during periods of duodenal regular motor activity).



Figure 4.

Canine gastrointestinal pressure activity during fasting: lower esophageal sphincter (LES) pressure recording during period of activity in fundus at paper speed of 25 mm/min. Note relationship of fundic pressure waves with LES pressure and antral activity and with transient decrease of duodenal phase III activity. Fundic waves occur at rhythm of 25% to 20% of antral frequency. See Figure 3 for representation of this phenomenon.

From Azpiroz and Malagelada 20


Figure 5.

Canine postcibal gastrointestinal motor activity recorded at paper speed of 10 mm/min. Barostat recorded pressure and volume of air within intragastric bag. Note postcibal volume initially remains at relatively low levels. However, later it increases gradually, reaching level higher than fasting level.

From Azpiroz and Malagelada 21


Figure 6.

Dynamics of gastric emptying. Data correspond to an idealized solid and liquid meal of ∼400 ml total volume, with a liquid‐to‐solid ratio of 1:1 (based on data from refs. 151–154 and J.‐R. Malagelada, unpublished observations).



Figure 7.

Antropyloric propulsion/retropulsion mechanism. See text for full description.



Figure 8.

Gastric accommodation and gastric emptying. Gastric accommodation (left) is primarily a function of proximal stomach. Gastric emptying (right) depends on coordinated action of proximal stomach, increasing intragastric pressure, and distal antrum, pylorus, and duodenum, acting to vary resistance.



Figure 9.

Effect of pylorus on gastric outflow in in vitro preparation from cat. Stomach was filled with saline solution. A: with draining cannula placed in duodenum, gastric output ceased and resumed multiple times, showing that pylorus imparts a pulsatile character to gastric outflow. B: when draining cannula was placed in the antrum itself, output ceased completely after short period.

From Schulze‐Delrieu and Brown 230


Figure 10.

Mean rates of gastric emptying (A, in ml/min; B, in kcal/min) for 18 combinations of volume and caloric density of meal fed to healthy volunteers. Rates calculated as linear slope from regression of energy delivered vs. time for all individual subjects, for each combination of meal volume and energy density. Means are plotted: ▴, 300‐ml meals; ▪, 400‐ml meals; and •, 600‐ml meals. Solid lines (B), linear regressions of mean caloric rate vs. energy density for each of three volumes; slopes of these lines are not significantly different.

From Hunt et al. 110


Figure 11.

Comparison of emptying of spheres with emptying of liver and of filter paper squares in dog. Slope ratios are plotted on ordinate as function of sphere diameter on abscissa. Points are means ± SE. Numbers in parentheses are numbers of repeated experiments in each group of dogs. Open circles and dashed line, spheres with density of 1; solid circles and solid line, spheres with density of 2. Cross, slope ratio for filter paper squares. Asterisks, significant differences from 1.0, i.e., from equal rates of emptying of spheres and liver.

From Meyer et al. 171


Figure 12.

Comparison of 50% gastric emptying and median small bowel transit for liquid and solid components of chyme for each of 6 healthy volunteers studied with a radioscintigraphic technique. Note that physical properties of food appear to have different influences on gastric emptying and intestinal transit: stomach selectively retains meal solids, but small bowel does not discriminate between solids and liquids. NS, not significant. DTPA, diethylenetriamine pentaacetic acid.

From Malagelada et al. 156


Figure 13.

Subjective scores for epigastric fullness during ingestion of meal and simultaneous infusion of either lipid emulsion (solid line) or saline control (dotted line) into ileum. Note earlier epigastric fullness with perfusion of ileal fat that delays gastric emptying (asterisk). Data are shown as means ± SE for 6 healthy volunteers; P < 0.05.

From Welch et al. 272
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Article Title: Determinants of gastric emptying and transit in the small intestine
 

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Juan‐R. Malagelada, Fernando Azpiroz. Determinants of gastric emptying and transit in the small intestine. Compr Physiol 2011, Supplement 16: Handbook of Physiology, The Gastrointestinal System, Motility and Circulation: 909-937. First published in print 1989. doi: 10.1002/cphy.cp060123