Functions of the GI Tract

Main function is digestion of ingested food & absorption of

digested nutrients
Processes involved:
GASTROINTESTINAL Motility of alimentary tract for propulsion & mixing of food
Secretion of various digestive juices & enzymes

PHYSIOLOGY Control of GI functions by neural & humoral mechanisms

Angela M.S. Poon

Vander, Sherman, Luciano, Human Physiology: The mechanisms of Body Function Ch 15

Processing of Food along GI Tract

Integrated Response
Mouth Intake of food, chewing; salivary secretion
Initiation of carbohydrate digestion to a Meal
Swallowing
Pharynx
1. Cephalic Phase
Transit of food to stomach
Esophagus 2. Oral Phase
Store, mix & dissolve food, controlled emptying
Stomach Initiation of protein digestion 3. Esophageal Phase
Carbohydrate, protein, fat digestion & absorption;
4. Gastric Phase
Duodenum
Jejunum
Pancreatic & biliary secretion
Electrolyte & water transport
5. Small Intestinal Phase
Ileum Bile salt & Vit B12 transport
6. Colonic Phase
Colon Storage, concentration of undigested material
Electrolyte & water transport
Propulsion of content

Rectum & Anus

Defecation

Vander, Sherman, Luciano, Human Physiology: The Mechanisms of Body Function Ch 15

1
 CEPHALIC and ORAL PHASE
The thought, sight, smell and taste of food results in
responses of GIT preparing for food digestion &
absorption
Psychological status (involving higher centers e.g.
SALIVARY
limbic system & hypothalamus) also affect GI
responses; responses can be positive or negative
SECRETION
Oral phase begins with contact of food with mouth,
involving taste & other receptors
GI responses are mostly neurally mediated involving
vagus & other nerves

Salivary Secretion
Salivary Secretion Composition of saliva:
Various ions (hypotonic, high K+)
Ion composition depends on stimulus and rate of
Saliva secreted by : salivary flow
Parotid, submandibular & sublingual glands pH 6.0 to 7.4
Numerous buccal glands secrete mucus into the Enzymes (amylase for starch digestion & small
oral cavity amount of lingual lipase for fat digestion)
Saliva contains: Mucin (glycoprotein, forms mucus when hydrated)
1. Serous secretion containing amylase Lysozyme (antibacterial)
2. Mucous secretion containing mucin

2
 Salivary Secretion Control of Salivary Secretion
Daily secretion about 1000 ml
Continuous basal & stimulated secretion
Secretion in two stages:
Primary secretion from acini
containing amylase, mucus,
extracellular fluid
Mucous cells in the acini secrete
mucin
Berne, Levy et al. Physiology Ch 27
Secondary secretion: Salivary ducts
modify the ionic composition
Composition various with rates of
secretion

Salivary Secretion
Salivary Secretion
Pavlovs conditioned reflex
Functions of saliva:
Water moistens & solubilizes food, increases
sensitivity of taste buds
Amylase initiates carbohydrate digestion;
lingual lipase digests fat
Mucus for lubrication
Neutralization of refluxed gastric juice
Maintains oral hygiene: salivary flow dilutes
harmful substances, lysozymes destroy
bacteria

3
 Swallowing (Deglutition) Swallowing Reflex
Swallowing is initiated by
Swallowing refers to the transit stimulation of pressure
of food from mouth, to the receptors around the
pharynx, down esophagus to opening of the pharynx by
stomach food
Transfer of food to pharynx is Afferent signals reach the
voluntary, thereafter under reflex swallowing centre in medulla
control (Swallowing reflex) oblongata & lower pons
Swallowing reflex also inhibits Send efferent ordered and
respiration & prevents the coordinated motor signals to
entrance of food into the trachea muscles in pharynx, larynx,
esophagus & respiratory
muscles
Guyton & Hall, Textbook of Physiology Ch 63

Movement of Food during Swallowing

1. Oral phase: Voluntary transfer of food or drink to pharynx by tongue Movement of Food through Esophagus
Pharyngeal Phase: Elevation of soft palate to prevent food from entering
2.
nasal cavity; larynx raised; glottis closed; respiration inhibited; Epiglottis
Primary peristaltic contractions
cover glottis to prevent food from entering trachea (aspiration) Initiated by mechanical stimulation of pharynx;
3. Esophageal phase: relaxation of upper esophageal sphincter; closure of Move materials through esophagus
sphincter after passage of food; glottis opens; breathing resumes;
peristaltic waves move food towards stomach; relaxation of lower
Secondary peristaltic contractions
esophageal sphincter; receptive relaxation of stomach; closure of lower Initiated by distension & local reflexes
esophageal sphincter. Remove any leftover material & reflux material from stomach
Upper esophageal sphincter protects airway from
swallowed material and gastric reflux
Lower esophageal sphincter tonically contracted,
preventing reflux of gastric content into the esophagus;
opens when a peristaltic swallowing wave moves
down esophagus
Vander, Sherman, Luciano, Human Physiology: The Mechanisms of Body Function Ch 15

4
 Movement of Food through Esophagus
Material moves from regions of higher intraluminal pressure
GASTRIC PHASE
to regions of lower pressure Berne, Levy et al. Physiology Ch 31 Functions of Stomach
1. Motor functions:
Reservoir
Mixing
Controlled emptying of food
2. Secretory functions:
HCl (digestion & antibacterial) Vander, Sherman, Luciano, Human Physiology: The Mechanisms of Body Function Ch 15

Intrinsic factor (Vit B12 absorption)

Pepsinogen (digestion)
Mucus & bicarbonate (protection)
Gastrin (control)
Histamine (control)

Gastric Storage & Mixing Gastric Emptying

Receptive relaxation of proximal stomach allows the
stomach to store ingested material with negligible
increase in pressure
Coordinated by swallowing centre, mediated by
vagovagal reflex
When food enters stomach, weak contractions
(triggered by slow waves) cause mixing of content with
gastric secretions;
Major mixing occurs in antrum due to stronger antral
contractions (retropulsion) against a closed pylorus,
propelling the chyme back into the antrum, causing
mixing & breaking down of food particles (grinding)
Strong peristaltic contractions cause gastric
emptying of chyme (semi fluid mass of partially
digested food) through pyloric sphincter into
duodenum (gastric emptying)
Control of gastric emptying
Rate of gastric emptying is regulated to ensure that gastric
contents are not emptied into the duodenum at a rate
faster than the small intestine can neutralize gastric acid
and process the chyme
Emptying triggered by gastric acidity, regulated by both
neural & hormonal mechanisms
Emptying slowed by hypertonic solutions in duodenum,
duodenal pH < 3.5, presence of fatty acids or
monoglycerides in the duodenum

5
 Secretions of Cell Types of Gastric Mucosa
Surface epithelial cells
Secretes mucus & an alkaline fluid
Protects epithelium from mechanical injury
& gastric juice
Neck mucous cells
Secretes mainly mucus, some pepsinogen
Chief (Peptic) cells
Secretes pepsinogens
Oxyntic (Parietal) cells
Secretes HCl & Intrinsic Factor
Enterochromaffin like (ECL) cells
Secretes histamine
D-cells
Secretes somatostatin
G-cells
Mainly in pyloric glands
Secretes gastrin
Functional Anatomy of the Stomach
Cardiac glandular region:
Secretes mucus
Proximal (80%):
Oxyntic gland mucosa
Parietal, chief & mucous neck cells
Secretes HCl, IF, pepsinogen,
mucus
Distal (Antral) (20%):
Pyloric gland mucosa
Mainly gastrin & mucous cells, few
chief cells, almost no parietal cells Berne, Levy et al. Physiology Ch 32
Secretes gastrin, small amount of
pepsinogen, mucus

Berne, Levy et al. Physiology Ch 32

Functions of Gastric Secretion Mechanism of HCl Secretion

Acid Converts inactive pepsinogen to active pepsin
(Parietal cells) Provides optimal pH for pepsin activity
Denatures ingested protein
Breaks up cells & connective tissue
Bacteriostatic

Pepsinogens Pepsin digests protein

(Chief cells)

Intrinsic Factor
Absorption of Vit B12 by ileal mucosa
(Parietal cells)

Mucus & Protects surface from acid and pepsin

Bicarbonate Gastric mucosal barrier
(Surface
Epithelial
cells)

Gastrin Promotes secretion of acid and pepsinogens

(G cells)
Berne, Levy et al. Physiology Ch 28

6
Control of Gastric Acid Secretion Three Phases of Gastric Secretion
Secretion of HCl by parietal cells Higher Three phases :
centers
Physiological stimulants: Cephalic Stimulus from higher centres (cortex,
1. Histamine (paracrine) Phase appetite center of amygdala or
Released from ECL cells 20% hypothalamus); nose and mouth
Act on H2 receptors (smell & taste of food); chewing
Strongest stimulant Gastric Stimulus arising from food in
2. Vagal stimulation (neural) Phase stomach
ACh acts on muscarinic receptors 70% Long vagovagal reflex, local enteric
3. Gastrin (hormonal) reflex, gastrin mechanism
Intestinal Stimulation from intestinal chyme
Secreted by G cells
Phase Minor
Stimulate histamine release 10%
Trophic effects on enterochromaffin cells
Stimuate acid secretion
Somatostatin inhibits gastric secretion

Cephalic & Gastric Phases of Gastric Secretion

Acid secretion, pepsinogen secretion & gastric motility affected at the

same time

Vander, Sherman, Luciano, Human Physiology: The Mechanisms of Body Function Ch 15

7
 Secretion of Pepsinogen
Pepsinogen has no digestive activity
At intragastric pH<5, pepsinogen is converted
into active pepsin by cleavage of acid-labile
linkages
Pepsin catalyses further conversion of
pepsinogen to pepsin
Pepsin may digest up to 20% of protein in a
typical meal
Pepsin most active at pH 3 and below
Gastric Mucosal Barrier
Berne, Levy et al. Physiology Ch 28
Secretion of Mucus and Bicarbonate
Secreted by mucous neck cells of gastric glands &
surface epithelial cells of stomach and duodenum
Bicarbonate secreted by surface epithelial cells
pH almost neutral at stomach surface
Forms a physical and alkaline barrier on stomach
surface protecting against acidic, proteolytic gastric
secretion
Gastric mucosal barrier
Adrenergic agonists decrease HCO3- secretion
(stress ulcer)
Imbalance of protective factors and acid secretion ulcers
Secretion of Intrinsic Factor
Glycoprotein secreted by parietal cells
Regulation of secretion same as that of acid
Required for absorption of Vitamin B12 at ileal
mucosa
Vitamin B12 required for DNA synthesis & RBC
maturation
Secretion of intrinsic factor is the only gastric
function that is essential for human life
Absence of intrinsic factor leads to megaloblastic
anaemia
Pernicious anaemia
8
 Functions of Stomach (Summary) SMALL INTESTINAL PHASE
Motor functions
Reservoir Functions of Small Intestine
Mixing 1. Digestion & Absorption of food:
Controlled emptying of food Carbohydrates
Secretory functions
Proteins
HCl (digestion & antibacterial)
Intrinsic factor (Vit B12 absorption) Fat
Pepsinogen (digestion) 2. Fluid & electrolyte absorption, Vit B12 absorption
Mucus & bicarbonate (protection) 3. Secretions of small intestine
Gastrin (control of gastric secretion) 4. Secretion of associated glands:
Histamine (control of gastric secretion)
Pancreatic exocrine secretion
Processing of Food
Initiation of protein digestion (20%) Hepatobiliary secretion & enterohepatic recirculation
Fat digestion (insignificant)
Intrinsic factor for VitB12 absorption

Pancreatic & Biliary Secretion

Digestion & Absorption in Intestine
Digestion takes place in duodenum & ileum
Digestion in the intestine by enzymes
secreted by pancreas & small intestine
Fat digestion and absorption aided by biliary
secretion
Almost all dietary protein, carbohydrate & fat
absorbed by small intestine
Absorption of fat soluble vitamins (A, D, E, K)
depend on fat absorption
Vit B12 absorption depends on Intrinsic factor
from stomach
Vander, Sherman, Luciano, Human Physiology: The Mechanisms of Body Function Ch 15

9
Pancreatic Exocrine Secretion
Acinar cells:
Secrete enzymes
Proteases secreted as inactive forms
For digestion of protein, carbohydrates & fat
Epithelial cells of pancreatic ducts:
Secrete bicarbonate
For neutralizing acidic chyme in stomach,
provide optimal pH for enzyme action

Control of Pancreatic Exocrine Secretions

Control of Pancreatic Exocrine Secretions
Cephalic
Cephalic Stimulated by sight, smell, taste of
Phase
Phase
food
Gastric Vagus releases ACh
Phase
Small amount of enzymatic
Intestinal secretion, which tends to stay in
Phase the duct

Gastric
Nervous stimulation
Phase Negligible contribution

10
 S cells secrete secretin, which I cells secrete CCK,
acts on the pancreatic ductal which stimulates the
cell to secrete bicarbonate secretion of pancreatic
* Intestinal Phase of Pancreatic Exocrine Secretions
enzymesSecretion
Intestinal Control of Pancreatic Exocrine

Major control
Acid chyme enters the duodenum, releases secretin from S
cells in duodenum & jejunum
Secretin stimulates secretion of large amount of fluid rich in
HCO3-
Partially digested protein & fat in duodenum causes release
of CCK from I cells in duodenum & jejunum
CCK stimulates secretion of pancreatic enzymes

Vagal, secretin & CCK effects are synergistic.

CCK also causes contraction of gall bladder to release bile and
relaxation of sphincter of Oddi
Johnson L.R., Essential Medical Physiology

Biliary Secretion
high level > liver will no
longer synthesize bile salts

Bile is a complex fluid containing water, electrolytes and a

battery of organic molecules including bile acids, cholesterol,
phospholipids and bilirubin from liver
First Stage: Hepatocytes secrete fluid rich in bile salts,*
reabsorption
cholesterol, and other organic components into canaliculi,
from which it flows into bile ducts
Second Stage: As bile flows through the bile ducts it is
modified by addition of a watery, bicarbonate-rich secretion
from ductal epithelial cells.
temporarilyBile is stored & concentrated in gall bladder between meals
through the absorption of water, sodium, chloride and other
electrolytes, while retaining and concentrating all the original
organic molecules.
During meals, gall bladder contracts & empties bile into
duodenum controlled by CCK Johnson L.R., Essential Medical Physiology Ch 34

11
Functions of Biliary Secretions
Digestive functions: DIGESTION & ABSORPTION
Bile acids:
Aid fat digestion & absorption
Promote absorption of fat soluble vitamins CARBOHYDRATES
Emulsification & formation of micelles
PROTEINS
HCO3- rich fluid
Neutralizes acidic chyme FAT
Excretory functions:
Bile pigments
Excess Cholesterol
Drugs

Carbohydrates
Main source of energy from diet Digestion of Carbohydrates

Starch digestion begins in the mouth:

Salivary -amylase digests starch to
oligosaccharides and disaccharides
Salivary digestion inhibited in the stomach by
acidic gastric juice
Carbohydrate digestion continues in small
intestine by alkaline pancreatic secretion
containing pancreatic -amylase

12
 glucose administration in treating diarrhea
Digestion of Carbohydrates
Oligosaccharides & dissacharides are broken down
into monosaccharides by enzymes located on the
brush border of small intestine epithelial cells
Absorption of Carbohydrates
Undigested cellulose & other complex
polysaccharides found in vegetable matter (fibres)
are passed onto the large intestine where they are
partially metabolized by bacteria
Most ingested carbohydrates are digested &
absorbed within first 20% of small intestine
Absorption of Carbohydrates
Glucose & galactose are absorbed actively by a sodium-
dependent carrier at brush border
Fructose by facilitated diffusion at brush border
All transported across basal membrane by facilitated
diffusion
reabsorption
Proteins
Important components of our bodys lean tissues
Essential for growth and maintenance of all tissues
Dietary proteins are chemically long chains of amino acids
bound together by peptide linkage
Present in meat products, grains, nuts etc
13
 Digestion of Proteins Activation of Pancreatic Proenzymes
Digestion of proteins to peptide fragments begins in the
stomach by pepsin;
Pepsin active at pH 2-3, inactive at pH >5
Pepsin secreted as pepsinogen; activated by acid & pepsin
Precursor
Protein digestion continues in the small intestine by
pancreatic proteases & intestinal peptidases

Johnson L.R., Essential Medical Physiology

Protein Digestion Protein Absorption

Proteins digested into Absorption mostly as amino
di-, tri- or acids, some di- & tri-
polypeptides and peptides are absorbed intact
amino acids by Absorption of most amino
acids by specific sodium-
pancreatic enzymes dependent carriers, some
in lumen by facilitated diffusion
Remaining protein A very small amount of
breakdown products intact proteins absorbed by
not broken down in combination of endocytosis
further digested by absorption > get into
and exocytosis; absorption
intestinal peptidases blood stream directly e.g.
antibodies of antibodies from the milk
on brush border & in in neonates provides some
cytoplasm immunity to the infant
Johnson L.R., Essential Medical Physiology

14
 Fat Digestion
Fat digestion occurs almost entirely in the small intestine
Lipids Pancreatic lipase digests triglycerides into monoglycerides and 2 free fatty
acids
Cholesterol esters and phospholipids are hydrolysed by 2 other pancreatic
lipases: cholesterol ester hydrolase & phospholipase A2
Lipids are important components of cell
membranes, some hormones, main source of
storage energy for our body
Dietary fat is primarily triglycerides, some
phospholipids and cholesterol
Most cholesterol in the form of cholesterol esters

Johnson L.R., Essential Medical Physiology

Fat Digestion Process Emulsification

emulsification The non-polar portions of
phospholipid & bile salt
associates with the non-
polar portion interior of the
lipid droplets, leaving the
polar portions exposed at
the water surface; repelling
other lipid droplets;
preventing re-aggregating
back into larger droplets
Mechanical disruption into
small droplets by
contractions of intestine;
Allows digestion by water
soluble pancreatic lipase at
surface of lipid droplet
Vander et al; Human Physiology: The Mechanism of Body Function Ch 15

15
 Formation of micelles Fat Absorption
Free molecules of fatty
Bile salts, fatty acids, phospholipids & acids and monoglycerides
monoglycerides cluster together with
the polar ends oriented toward the diffuse into intestinal
micelles surface & the non-polar
portions forming the core; epithelial cells
Micelles are in equilibrium with the fat
digestion products that are free in
Resynthesized into
solution; triglycerides in
As free lipids are absorbed by endoplasmic reticulum
diffusion, more lipids are released
into the free phase as micelles break Droplets of triglycerides
down
Micelles provide a means of storage
secreted as chylomicrons
of insoluble fat until they are which pass into lacteals
absorbed
Cholesterol & fat-soluble vitamins are Lymph empties into
also found in core of micelles systemic veins via
thoracic duct
Vander et al; Human Physiology: The Mechanism of Body Function Ch 15
Vander et al; Human Physiology: The Mechanism of Body Function Ch 15

Absorption of Vitamins Secretions of Small Intestine

Absorption of fat soluble vitamins (Vit A, D, E & K)
Follow the pathway for fat absorption
Fat malabsorption may lead to deficiency of fat
soluble vitamins
Absorption of water soluble vitamins
Rapid, mostly in upper small intestine
Vit B12 absorption depends on intrinsic factor
from stomach, absorption in ileum
1. Mucus & bicarbonate from Brunners gland in
duodenum: mucus protects duodenal wall from
digestion by highly acidic gastric juice;
bicarbonate neutralizes acid
2. Mucus from intestinal globet cells: lubricates &
protects the intestinal surface
3. Aqueous isotonic fluid from enterocytes:
important for absorption of nutrients
4. Digestive enzymes from enterocytes: digestion of
small peptides, dissacharides and lipids

16
 Daily Fluid Movement in the Gut
Daily intake:1-2 L fluid, 10 g salt
Daily secretion (from salivary
glands, stomach, bile, pancreas,
small intestine) into lumen: 7 L
85% of load absorbed by small
intestine
About 1.5 L enter the colon
95% of colon load absorbed by
large intestine
Thus, about 99% of fluid
absorbed, 1% excreted in feces
Large absorptive reserve
capacity in large intestine
Vander, Sherman, Luciano, Human Physiology: The Mechanisms of Body Function Ch 15
The ileocecal sphincter
relaxes when the ileum
is distended &
contracts when the
colon distends: allows
material to enter the
colon and preventing
reflux
Guyton & Hall, Textbook of Physiology
Motility of Small Intestine
Two types of contractions
1. Mixing (segmentation) contractions:
Closely spaced contractions of
circular muscle layer
for mixing chyme with digestive
juices
2. Peristaltic contractions:
Progressive contractions of
successive sections of circular
smooth muscle
Propels chyme slowly along small
intestine
Long transit time allows efficient
digestion & absorption
COLONIC PHASE
Functions of Large Intestine
1. Digestion & Absorption of components of food that
cannot be digested/absorbed more proximally
2. Reabsorption of remaining fluid in the GIT
3. Store waste products & eliminate them
Defecation reflex
17
 Motility of Large Intestine
Secretions of Large Intestine 1. Inactive most of the time
2. Combined segmentation contractions of the circular
Secretes mucus: muscles & longitudinal muscle strips (teniae coli) caused
the unstimulated portions of the large intestine to bulge
1. protects the wall
outward into haustrations causing mixing
2. provides an adherent medium for 3. Weak peristaltic contractions in proximal colon: permits
holding fecal matter together storage of contents and absorption of most remaining
water
4. Two or three times per day, a peristaltic wave (mass
movement) propels a significant amount of material into
the distal colon or rectum. Distension of rectum triggers
defecation reflex
5. Initiation of mass movements by gastrocolic & duodenal
colic reflexes

Defecation Reflex Defecation

Anus is normally closed by
Anus is normally closed by internal (smooth muscle) and internal (smooth muscle)
external anal sphincters (skeletal muscles) and external anal
sphincters (skeletal
Defecation reflex initiated by mass movement of feces into muscles)
the rectum Internal anal sphincter
Stimulation of rectal mechanoreceptors leads to reflex innervated by pelvic
nerves (parasympathetic)
increase in peristalsis in descending & sigmoid colon, & external anal sphincter
relaxation of internal anal sphincter and initial reflex innervated by pudendal
contraction of external sphincter; further increase in nerve (somatic; under
pressure triggers reflex relaxation of external sphincter voluntary control)
accompanied by conscious urge to defecate; if the Defecation reflex initiated
by mass movement of
external sphincter is also voluntarily relaxed at the same feces into the rectum
time, defecation occurs Integrating centre in sacral
Central nervous system can voluntarily override the reflex spinal cord
relaxation of external anal sphincter, delaying defecation.

18
 Learning Objectives
Different phases of integrated responses to food: cephalic, oral,
esophageal, stomach, small intestinal & colonic
Salivary secretion: content, function, control of secretion
Swallowing reflex
Esophageal phase
Stomach: motor function and gastric secretions
Gastric secretions: acid, enzymes, intrinsic factor, mucus,
bicarbonate
Control of gastric acid secretion: phases, regulatory
mechanisms
Pancreatic & biliary secretions and control processes
Digestion and absorption of carbohydrates, protein & fat
GI fluid balance
Secretions in small & large intestine
Mixing and peristaltic contractions of small & large intestine
Guyton & Hall, Textbook of Physiology
Defecation reflex

References
1. Vander, Sherman, Luciano, Human Physiology:
The mechanisms of Body Function Ch 15
2. Guyton & Hall, Textbook of Physiology Ch 66.
3. Johnson L.R., Essential Medical Physiology
Ch 34
4. Berne & Levy. Physiology. Ch 26-31.

19