Gastric Motility and Gastric Emptying
Daniel K. Podolsky MD
President, University of Texas Southwestern Medical Center, Professor of Internal Medicine, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA
Search for more papers by this authorMichael Camilleri MD
Executive Dean for Development, Atherton and Winifred W. Bean Professor, Professor of Medicine, Physiology and Pharmacology, Distinguished Investigator, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorJ. Gregory Fitz MD FAASLD
Executive Vice President for Academic Aff airs and Provost, University of Texas Southwestern Medical Center, Dean, Professor of Internal Medicine, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA
Search for more papers by this authorAnthony N. Kalloo MD
Professor of Medicine, Johns Hopkins University School of Medicine, Director, Division of Gastroenterology & Hepatology, Johns Hopkins Hospital, Baltimore, MD, USA
Search for more papers by this authorFergus Shanahan MD
Professor and Chair, Department of Medicine, Director, Alimentary Pharmabiotic Centre, University College Cork, National University of Ireland, Cork, Ireland
Search for more papers by this authorTimothy C. Wang MD
Chief, Division of Digestive and Liver Diseases, Silberberg Professor of Medicine, Department of Medicine and Irving Cancer Research Center, Columbia University Medical Center, New York, NY, USA
Search for more papers by this authorSummary
The anatomic orientation of the gastric smooth muscle layers (longitudinal, circular, and oblique) serves the need to regulate accommodation, dispersion, trituration, and emptying of food. Gastric smooth muscle is innervated by extrinsic nerves that relay information to and from extrinsic ganglia, spinal cord, and central nervous system, and by intrinsic nerves in the gastric wall. This chapter summarizes neurons that control digestive functions, their predominant transmitters and stimulatory or inhibitory actions. The small intestine modulates gastric emptying and plays a pivotal role in regulating gastric and pyloric motor activity. Interruption of vagal innervation of the proximal stomach does not modify emptying of indigestible spheres, whereas distal gastric vagotomy delays their passage into the duodenum. Feedback inhibition of emptying by intestinal factors is crucial to regulating duodenal caloric delivery. The effects of many hormones and neurotransmitters on gastric emptying reflect their effects on gastric motility.
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