Introduction
The digestive and absorptive functions of the gastrointestinal system outlined in the previous chapter depend on a variety of mechanisms that soften the food, propel it through the length of the gastrointestinal tract, and mix it with hepatic bile stored in the gallbladder and digestive enzymes secreted by the salivary glands and pancreas. Some of these mechanisms depend on the intrinsic properties of the intestinal smooth muscle. Others involve the operation of reflexes involving the neurons intrinsic to the gut, reflexes involving the central nervous system (CNS), paracrine effects of chemical messengers, and gastrointestinal hormones.
General patterns of motility
Peristalsis is a reflex response that is initiated when the gut wall is stretched by the contents of the lumen, and it occurs in all parts of the gastrointestinal tract from the esophagus to the rectum. The stretch initiates a circular contraction behind the stimulus and an area of relaxation in front of it (Figure 28–1). The wave of contraction then moves in an oral-to-caudal direction, propelling the contents of the lumen forward at rates that vary from 2 to 25 cm/s.
Segmentation & mixing
When the meal is present, the enteric nervous system promotes a motility pattern that is related to peristalsis but is designed to retard the movement of the intestinal contents along the length of the intestinal tract to provide time for digestion and absorption. This motility pattern is known as segmentation, and it provides for ample mixing of the intestinal contents with the digestive juices. A segment of bowel contracts at both ends, and then a second contraction occurs in the center of the segment to force the chyme both backward and forward.
Migrating motor complex
During fasting between periods of digestion, the pattern of electrical and motor activity in gastrointestinal smooth muscle becomes modified so that cycles of motor activity migrate from the stomach to the distal ileum. Each cycle, or migrating motor complex (MMC), starts with a quiescent period (phase I), continues with a period of irregular electrical and mechanical activity (phase II), and ends with a burst of regular activity (phase III). The MMCs are initiated by motilin, migrate aborally at a rate of about 5 cm/min, and occur at intervals of approximately 90 min. Gastric secretion, bile flow, and pancreatic secretion increase during each MMC.
Mastication
Chewing (mastication) breaks up large food particles and mixes the food with the secretions of the salivary glands. This wetting and homogenizing action aids swallowing and subsequent digestion. Large food particles can be digested, but they cause strong and often painful contractions of the esophageal musculature. Particles that are small tend to disperse in the absence of saliva and also make swallowing difficult because they do not form a bolus. The number of chews that is optimal depends on the food but usually ranges from 20 to 25.
Swallowing
Swallowing (deglutition) is a reflex response that is triggered by afferent impulses in the trigeminal, glossopharyngeal, and vagus nerves. These impulses are integrated into the nucleus of the tracts solitarius and the nucleus ambiguous. The efferent fibers pass to the pharyngeal musculature and the tongue via the trigeminal, facial, and hypoglossal nerves. Swallowing is initiated by the voluntary action of collecting the oral contents on the tongue and propelling them back into the pharynx. This starts a wave of involuntary contraction in the pharyngeal muscles that pushes the material into the esophagus. Inhibition of respiration and glottis closure are part of the reflex response. A peristaltic ring contraction of the esophageal muscle forms behind the material, which is then swept down the esophagus at a speed of approximately 4 cm/s. When humans are in an upright position, liquids and semisolid foods generally fall by gravity to the lower esophagus ahead of the peristaltic wave.
Gastric motility & emptying
When food enters the stomach, the fundus and upper portion of the body relax and accommodate the food with little if any increase in pressure (receptive relaxation). Peristalsis then begins in the lower portion of the body, mixing and grinding the food and permitting small, semiliquid portions of it to pass through the pylorus and enter the duodenum.
Receptive relaxation is vitally mediated and triggered by the movement of the pharynx and esophagus. Peristaltic waves controlled by the gastric BER begin soon thereafter and sweep toward the pylorus. The contraction of the distal stomach caused by each wave is sometimes called astral systole and can last up to 10 s. Waves occur three to four times per minute.
Summary
The regulatory factors that govern gastrointestinal secretion also regulate its motility to soften the food, mix it with secretions, and propel it along the length of the tract.
Two major patterns of motility are peristalsis and segmentation, which serve to propel or retard/mix the luminal contents, respectively. Peristalsis involves coordinated contractions and relaxations above and below the food bolus.
