Further observations upon reflex gastric hypermotility

Abstract

Increase in the force or rate or change in the direction of gastric contractions have followed irritation of the gallbladder, duodenum, or appendix, experimentally, and these motor changes have been associated with pathological gallbladders, duodenums, and appendices, clinically. 1 It may be assumed, subject to further experimental proof, that these organs constitute three of the possible foci of reflex gastric stimulation. Were the nerve paths known along which these impulses travel, it might be possible to explain these motor responses and group other possible causes of gastric motor unrest.

Other observations of abnormal reflex gastric activity in which the pyloric and fundic parts functionate separately are the following:

1. Prostalsis of the pars pylorica, alone, occurring in the course of irritation of the above organs and after thoracic vagus section.

2. Anastalsis of the pars pylorica, alone, associated with traumatization of the gallbladder.

3. Pro- and anastalsis of the pars pylorica, alone, after extragastric traumata before the stomach appears to settle down to definite rhythmical contractions and is produced mechanically by dividing or blocking the stomach at the junction of the pyloric part and the fundus. It also follows thoracic division of the vagi.

4. Pylorospalsm, diffuse, with fundic relaxation resembling apylorofundic intussusception (see diagram).

This fourth type has been observed repeatedly under experimental traumatization of the gallbladder, duodenum, or appendix and once in the human with evidence of appendical and gallbladder disease. It can be produced by direct stimulation of the lesser curvature at the junction of the descending and horizontal arms. The subjective evidence, associated with this motor state, is anorexia, vomiting, and epigastric pain. The objective signs are mass and tenderness over the stomach, present at times and absent at other times. This form of motility, as appears to be the rule with the reflex types, disappears with parietal peritoneal irritation.