Introduction to the

gastrointestinal motility
Introduction
• The term motility is defined as involuntary mobility
of tubular organs.
• To ensure the efficient digestion of food is necessary
not only the presence of active enzymes, but also a
shift and mixing of chyme during passage through
the digestive tube.
• For this purpose, there are two types of movements
in the GIT:
1) Propulsion movements
2) Mixing movements
• This division is artificial, because, in fact, both types of
movements use the same mechanisms and often one
can convert to the other.
Propulsion movements
• Propulsion movements are movements that provide
movement of chyme in the digestive tract.
• And a rate that is proportional to the rate of
absorption and digestion.
• Basic propulsion movement is called peristalsis.
• Its principle is simple: circular muscle layer in a certain place contracts and
creates contractile ring, which is further shifted in the aboral direction. Thus it
slowly pushes chyme ahead.
• Distension of the intestine is often an impulse for the formation of the
contractile ring – and thus for the initiation of peristalsis. Larger quantity of the
chyme causes distention and thereby stimulating the enteric nervous system.
• This triggers the contraction of the circular muscle segment that is a few inches
orally from the place of maximal distension of the tube.
• Peristalsis is also triggered by certain chemical stimuli or
strong parasympathetic activation. It also occurs
automatically at certain intervals. In addition to the
contraction orally of the distended segment, occurs so
called receptive relaxation aborally from the distended
segment of the tube. This facilitates the movement of
the chyme, as relaxed tube brings less resistance to the
moving chyme. This whole process is controlled by
Auerbach’s plexus (or myenteric plexus) and is called
the peristaltic reflex.
• Propulsion movements can be experimentally cause also in oral
direction, but they disappear after few millimeters. The peristaltic
movements are therefore unidirectional, although the physiological
basis for this phenomenon is not yet completely understood.
• Mixing movements
• Mixing movement ensures constant mixing of chyme, so that the
entire volume of the nutritionally important components is exposed
to enzymes and came into a contact with the lining of the intestine to
be absorbed. These movements have different forms and varies
throughout the digestive tract.
• Segmentation
• Segmentation is well understood mixing movement. We can imagine it
as repeated contractions of several centimeters distant sections of
circular smooth muscle. Contracted regions differ after each
segmentation cycle. Thus is the chyme segmented – formation of
separated portions of the chyme, which are subsequently again
divided and one half is combined with a portion of the previous one
and second portions with the following. Number of portions gradually
increases and their volume on the other hand decreases, as one half of
the two outer portions always has nowhere to attach and forms a new
portion.
• The motility of the stomach
• Stomach is thanks to arrangement of its muscle well equipped to
perform three functions:
• 1) Mixing of food
• 2) Storage of large amounts of food
• 3) Emptying into the duodenum
• Mixing of food
• Until chyme is present in the stomach, weak contraction waves (called
mixing waves) are formed in its upper third. They appear regularly
every 20 seconds and are based on automaticity of the smooth
muscle. Once the mixing wave extends from the body of the stomach
to the antrum, it becomes more powerful and strongly pushes chyme
to the pylorus. However, as the pyloric sphincter is closed, encounters
the chyme to the blind endings and only mix, respectively, under the
high pressure escapes back against the movement of contractile ring.
This phenomenon is called retropulsion.
• It is good to note that the pyloric sphincter is never completely
closed. Chyme which escape through it, has the volume only a few
milliliters, but it has an important function as duodenum can tests its
composition and according to that gastric motility is adjusted. This
phenomenon, which is additive to the retropulsion mixing, is called
pyloric pump.
• Gastric emptying
• Gastric emptying has the same mechanism as retropulsion. Simultaneously, it is
however accompanied by a decrease in resistance against the passage of chyme
through the pylorus – relaxation of the pyloric sphincter occurs. Thus certain
volume of chyme can pass into the duodenum – depending on the resistance of
the pylorus at a given time. Generally speaking: the higher the sphincter tone is,
the higher the resistance against the passage of chyme through pylorus and the
smaller volume of chyme enters the duodenum.
• The pyloric sphincter is really just a thicker layer of a regular circular
muscles. He has about double thickness in the pylorus compared to
the rest of the stomach. Normally, its tone is set so that the resistance
is small enough for the passage of fluids, but too large for passage of
solid chyme. It must go through several retropulsion mixing and be
sufficiently mixed with the gastric juices to continue into the
duodenum.
• Gastric emptying is controlled by several factors that can be divided
into two groups:
• 1) Gastric factors
• 2) Duodenal factors
• Gastric factors
• Gastric factors generally potentiate gastric emptying by increasing the
frequency of the mixing waves or by reducing the pyloric tone. They
are activated if there is a larger amount of food in the stomach (and
especially food rich in proteins, e.g. meat). Contact of peptides with
antrum mucosa causes secretion of gastrointestinal hormone gastrin.
• Gastrin has the following effects:
• 1) Increases the production of gastric juice that has low pH
• 2) Increases the frequency of spontaneous motor activity of the
stomach (mixing waves)
• 3) Decreases the pyloric sphincter tone
• Note that if there is a sudden increase of the frequency of mixing
waves and a decrease of pyloric sphincter tone, increased efficiency
of the pyloric pump occurs. This is the main mechanism of increased
gastric emptying.
• Duodenal factors
• These are mostly inhibitory signals that block gastric emptying. There
are two main groups:
• 1) Nerve feedback to enterogastric system
• 2) Feedback control through the gastrointestinal hormones
• Nerve feedback to enterogastric system
• If large volume of chyme passes through the pyloric sphincter into the
duodenum, there is a distension of its wall leading to a reflex that
slows down or completely stops gastric emptying.
• This signal is mediated:
• 1) Directly by the enterogastric system
• 2) Through the paravertebral sympathetic ganglion
• 3) Through the vagus nerve to the brainstem and back
• All of them are called pyloric reflexes. Their effect is dual:
• 1) Decreased frequency of mixing waves
• 2) Increased tone of the pyloric sphincter
• This slows down the mechanism of the pyloric pump.
• In addition to the volume of the chyme, the pyloric reflexes are
activated by the low pH (3.5-4), high concentration of peptides in the
chyme and its hypertonicity or hypotonicity.
• Feedback control through the gastrointestinal hormones
• Epithelial cells of the duodenum exhibit sensory activity for certain
types of nutrients. They activate pyloric reflexes when there are
changes in pH, peptide concentration or tonicity. In the presence of
lipids they accelerate the secretion of these mediators (not only in the
presence of lipids but to lipids the are the most sensitive):
• CCK – cholecystokinin
• This hormone has three important effects. It reduces the activity of
the pyloric pump, blocks the effect of gastrin on gastric motility and
increases the secretion of bile into the chyme, as it activates
contractions of the gallbladder.
• Secretin
• Secretin is produced by duodenal cells as a response to the low pH of
the chyme. It inhibits gastric emptying.
• GIP – gastric inhibitory peptide
• GIP is produced as a response to the high lipid content in the chyme.
Although it has an inhibitory effects on the gastric motility and
especially on the the pyloric pump it is the weakest one of all three
hormones.
• Motility of the small intestine
• Contractions of the muscle layers of the small intestine can be divided into two groups:
• 1) Segmentation contractions
• 2) Propulsion contractions
• Segmentation contractions
• Process of the segmentation has already been discussed above. We only briefly discuss
its causes here. Segmentation is a manifestation of electrical slow-waves, which
represent action potentials generated by the automaticity of smooth muscle. Maximal
frequency of these slow waves is 12/min. Therefore, segmentation can also occur up
to 12 times per minute, but only in very rare cases. The normal frequency of
segmentation movement is about 3 per minute.
• Propulsion contractions
• Their mechanism has already been described in the introduction part.
The contractile ring in the small intestine has a velocity of about 0.5-2
cm/min. Faster in the proximal segments, in distal segments it slows
down. One contractile ring travels a maximal distance of 10 cm, then
it goes out and chymus wait for the new one. Therefore, the overall
speed of passage of chyme is 1 cm/min.
• Control of the motility of the small intestine
• There is an increase of propulsion movements in the small intestine
after each meal. This is due to both the presence of chyme in the
small intestine and the gastroenteric reflex. This reflex is a response
to the stretching of the stomach wall and it raises the motility of the
bowel. Components of this reflex lies completely in the myenteric
plexus. Furthermore, hormones act – CCK, gastrin, insulin, motilin.
They are secreted postprandially and increase the frequency of
propulsion and mixing movements. Conversely, secretin and glucagon
inhibit the motility of the small intestine.
• Ileocecal valve
• Function of this valve is to prevent reflux of chyme from colon into
the small intestine. In fact, it is not a valve, but the orifice of the
terminal ileum, which protrudes into cecum. But due to the amount
of muscle it works as a valve. Its function depends on its resistance.
About 1500-2000 ml/day of chyme passes through.
• Motility of the colon
• Colon has two main functions: to absorb electrolytes and water and
to store solid wastes before they are eliminated from the body. Both
of these functions require no extensive motor activity. Therefore, the
longitudinal muscle layer is in the colon reduced to the taenia. They
represent three bands of muscle that stretch along the entire length
of the colon. Its motility is thus slower than that of the small intestine.
Haustration
• It is a mixing movement of the colon (a modified segmentation
movement). First, there is a circular muscle contraction. Subsequently
taeniae contract forming the haustrum. Haustra form the
characteristic appearance of the colon, which is composed of a series
of relatively large bulges. During the contractions of taenia, there is an
increased pressure inside haustra. After about 30 seconds the
pressure reaches its maximum and in next 60 seconds the haustrum
disappears. Formation of a new haustrum starts after several minutes
at a new place (segmentation movement), and the whole process is
repeated.
• Propulsion movements
• Propulsion movement is mostly determined by the haustration which
progressively and slowly progresses from the cecum to the sigmoid
colon. Passage of digested material through the colon by haustration
held for about 12 hours and the liquid chyme becomes solid fecal matter.
• However, there is a faster propulsion movement of the colon, that occurs
three times a day for about an hour after a meal and lasts only for 15
minutes. It reminds peristalsis. There is a contraction ring, which
gradually moves in aboral direction. It arises in the transverse colon
and normal haustration activity disappears for about 15 minutes.
• Modulation of colon motility
• All described colon movements grow in intensity and frequency when
two reflexes are triggered:
• 1) Gastrocolic reflex
• 2) Duodenocolic reflex
• Gastrocolic reflex
• Gastrocolic reflex is triggered by a high tension in the stomach wall.
Myenteric plexus transports this signal through to the colon that
increases the frequency of haustra formation.
• Duodenocolic reflex
• Duodenocolic reflex is triggered by a high tension in the duodenal
wall. Signal spreads through the myenteric plexus to the colon and
increases the frequency of action potentials in the smooth muscle
cells. That increases speed of the propulsion movements.