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.


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