The Pyloric Sphincteric Cylinder in Health and Disease



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Chapter 12 (page 49)

Discussion

It is concluded that the pyloric aperture was open at rest in 52 of 100 normal subjects. Its diameter, as measured on the films, varied from a minimum of 4.0 mm to a maximum of 10.0mm in different subjects.

In the remaining 48 subjects some delay or hold-up occurred at the pyloric ring. In the majority of these the hold-up lasted from 40 to 90 seconds; in a few the hold-up was longer, lasting from 90 seconds to 3 minutes. In this latter subgroup the delay at the pylorus was associated with hypotonicity or sagging of the greater curvature of the stomach. Tilting the table by 45 degrees and turning the patient into the left anterior oblique position, caused immediate gastric emptying in the absence of radiologically visible contractions. It is concluded that visible contractions are not necessary for emptying of liquid barium in this position.

It appears that the delay in emptying in these 48 subjects was either due to hypotonicity of the gastric musculature (Chap. l9), or to closure of the pyloric aperture. Different types of closure of the aperture may occur (Chap. 13); in the present cases the pyloric sphincteric cylinder was expanded, and the radiological features suggest that closure of the aperture was due to converging or spiral (“iris-like”) gastric mucosal folds (Chap. 13).

References

  1. Andersson S, Grossman MI. Profile of pH, pressure and potential difference at gastroduodenal junction in man. Gastroenterology l965, 49, 364-371.
  2. Atkinson M, Edwards DAW, Honour AJ, et al. Comparison of cardiac and pyloric sphincters. Lancet l957, 273, 918-922.
  3. Brink BM, Schlegel JF, Code CF. The pressure profile of the gastroduodenal junctional zone in dogs. Gut l965, 6, 163-171.
  4. Fisher RS, Cohen S. Physiological characteristics of the human pyloric sphincter. Gastroenterology l973, 64, 67-75.
  5. Gaffney PR, Gleeson DJ, Hall JW, et al. The manometric findings at the human pylorus: the evidence against the presence of a tonic sphincter. Scand J Gastroenterol l987, 22, 525-532.
  6. Isenberg JI, Csendes A. Effect of octapeptide of cholecystokinin on canine pyloric pressure. Amer J Physiol l972, 222, 428-431.
  7. Kaye MD, Mehta SJ, Showalter JP. Manometric studies of the human pylorus. Gastroenterology l976, 70, 477-480.
  8. McShane AJ, O'Morain C, Lennon JR, et al. Atraumatic non-distorting pyloric sphincter pressure studies. Gut l980, 21, 826-828.
  9. White CM, Poxon V, Alexander-Williams J. A study of motility of normal human gastroduodenal region. Dig Dis Sci l98l, 26, 609-617.


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