The Pyloric Sphincteric Cylinder in Health and Disease



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Chapter 23 (page 111)

Conclusion

It has been shown that the pyloric sphincteric cylinder is a specialized muscular region of the stomach (Chap. 3), normally lined by pyloric mucosa (Chap. 5). In the vast majority of subjects its vagal supply occurs exclusively via the hepatic branch or branches (Chap. 8). Its motility is unique (as far as the stomach is concerned) in that it contracts cyclically in a "segmental" or "systolic", rather than a peristaltic way (Chap. 13). The contractions depend on and are triggered by underlying myoelectric activity (Chap. 16). In our view any one, or a combination of these factors, may have a bearing on the pathogenesis.

The contraction of the hypertrophied musculature in IHPS closely resembles a normal maximal or near-maximal contraction of the pyloric sphincteric cylinder (Chap. 13). In the former the contraction is permanent, in the latter of a fleeting nature, occurring in cycles with a frequency of approximately 3 per minute during active gastric emptying of solids. Normally when the cylinder is fully contracted, its lumen is obliterated by closely packed longitudinal mucosal folds; barium-filling of furrows between the folds may resemble lines or strings (Chap.13). A similar appearance of the mucosa is seen in IHPS, where barium-filling of longitudinal mucosal furrows in the hypertrophied and contracted cylinder gives rise to the "string sign" (Fig. 23.0). In a sense IHPS can be looked upon as the pathological counterpart of a maximal normal, physiological contraction of the sphincteric cylinder.

Radiologically and ultrasonically the narrowing of pylorospasm resembles that of IHPS in many respects (Meuwissen and Sloof l932; Torgersen l942; Astley l952; Shopfner l964; Haran et al. l966; Swischuk l980; Blumhagen and Coombs l98l; Bowen l988), showing that pylorospasm is not limited to the pyloric ring, but involves the entire pyloric sphincteric cylinder.

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