The Pyloric Sphincteric Cylinder in Health and Disease



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Chapter 18 (page 86)

None of the authors quoted above correlated their findings with the muscular anatomy of the distal stomach as described by Cunningham (l906), Forssell (l913) and Torgersen (l942).

Radiographically the emptying of a mixed meal consisting of liquids, solids and barium sulphate suspension, is seen to be associated with vigorous cyclical contractions of the pyloric sphincteric cylinder (Chap. 13). Solids present as defects in the barium; softish solids may be observed to change in shape during contraction of the cylinder. It is our submission that cyclical contractions of the pyloric sphincteric cylinder will explain the "antropyloric muscular function" mentioned by Horowitz et al (l982), the "antral phasic pressure activity" of Camilleri et al (l986) and the "antral and duodenopyloric mechanism" of Velchik et al (l989).

Camilleri et al. (l986) found that antral phasic pressure activity played a role not only in propulsion of liquids and solids from the stomach, but also in trituration of solid food. Contraction of the pyloric sphincteric cylinder may at times be associated with retropulsion of barium suspension into the stomach (Chap. 13), retropulsion of its mucosal folds (Chap. 13), and retropulsion of sessile mucosal polyps (Chap. 36). Whether propulsion or retropulsion occurs, depends on the interplay between the right and left pyloric muscular loops (Chap. 13). It is probable that contraction of the cylinder, especially in the absence of propulsion or retropulsion, may be associated with trituration of solid particles. In diabetic gastroparesis failure of contraction of the cylinder was seen to be associated with failure of trituration (and propulsion) of solid tablets (Chap. 37).

According to Camilleri et al. (l986) radionuclide and manometric emptying studies provide closely interrelated physiological studies and may be regarded as complementary diagnostic tools. It seems that upper gastrointestinal radiographic studies may likewise assist in the clarification of problems of gastric emptying.

References

  1. Camilleri M, Malagelada JR, Brown ML, et al. Relation between antral motility and gastric emptying of solids and liquids in humans. Amer J Physiol l985, 249 (Gastrointest Liver Physiol 12) : G580-G585.
  2. Camilleri M, Brown ML, Malagelada JR. Relationship between impaired gastric emptying and abnormal gastrointestinal motility. Gastroenterology l986, 9l, 94-99.
  3. Collins PJ, Horowitz M, Cook DJ, et al. Gastric emptying in normal subjects: a reproducible technique using a single scintillation camera and computer system. Gut l983, 24, 1117-1125.
  4. Cunningham DJ. The varying form of the stomach in man and the anthropoid age. Trans Roy Soc Edin l906, 45, 9-47.
  5. Forssell G. Über die Beziehung der Röntgenbilder des menschlichen Magens zu seinem anatomischen Bau. Forschr Geb Röntgenstr l913, Suppl 30, 1-265.
  6. Griffith GH, Owen GM, Kirkman S, et al. Measurement of rate of gastric emptying using Chromium - 51. Lancet l966, 1, 1244-1245.
  7. Griffith GH, Owen GM, Campbell H, et al. Gastric emptying in health and in gastroduodenal disease. Gastroenterology l968, 54, 1-7.
  8. Heading RC, Tothill P, McLoughlin GP, et al. Gastric emptying rate measurement in man: a method for simultaneous study of solid and liquid phases. Gut l974, 15, 841.
  9. Heading RC, Tothill P, McLoughlin GP, et al. Gastric emptying rate measurement in man: a double isotope scanning technique for simultaneous study of solid and liquid phases. Gastroenterology l976, 71, 45-50.
  10. Hinder RA, Kelly KA. Canine gastric emptying of solids and liquids. Amer J Physiol l977, 233 (Endocrinol Metab Gastro-intest Physiol 2): E335-E340.
  11. Horowitz M, Cook DJ, Collins PJ, et al. The application of techniques using radionuclides to the study of gastric emptying. Surg Gynaec Obstet l982, 155, 737-744.
  12. Malagelada JR. Quantification of gastric solid-liquid descrimination during digestion of ordinary meals. Gastroenterology l977, 72, 1264-1267.
  13. Meyer JH, MacGregor IL, Gueller R, et al. 99mTc-tagged chicken liver as a marker of solid food in the human stomach. Amer J Dig Dis l976, 21, 296-304.
  14. Meyer JH. New dimensions in gastric physiology. Dig Dis Sci l979, 24, 97-100.
  15. Meyer JH. Gastric emptying of ordinary food: effect of antrum on particle size. Amer J Physiol l980, 239 (Gastroint Liver Physiol 2); G133-G135.
  16. Read NW, Al-Janabi MN, Holgate AM, et al. Simultaneous measurement of gastric emptying, small bowel residence and colonic filling of a solid meal by the use of the gamma camera. Gut l986, 27, 300-308.
  17. Sheiner HJ. Gastric emptying tests in man. Gut l975, 16, 235-247.
  18. Torgersen J. The muscular build and movements of the stomach and duodenal bulb. Acta Rad l942, Suppl 45, l-l91.
  19. Velchik MG, Reynolds JC, Alavi A. The effect of meal energy content on gastric emptying. J Nucl Med l989, 30, 1106-1110.


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