01 PHYSIOLOGY
23. Gastric regulation
Describe what happens in the GI
tract when a meal is anticipated.
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There are three main phases of gastric regulation:
> Cephalic phase
> Gastric phase
> Intestinal phase.
Cephalic phase
These reflexes are decreased by stimulation of the sympathetic nervous
system with, for example, pain, fear and anxiety.
Thought, sight and smell of food
Stimulates
Cerebral cortex and hypothalamus
Stimulates
Medulla oblongata
Impulses from medulla travel via vagus
Vagus nerve
Submucosal plexus
Stomach – ↑ Gastric Juices Blood – ↑ Gastrin
Fig. 23.1  Cephalic phase
Gastric phase
> As food and fluid enter the stomach, stretch and chemoreceptors are
activated.
> This leads to a further increase in gastric secretions and increases
peristalsis.
> The tone of the lower oesophageal sphincter is increased to prevent
reflux of acid.
> Once the pH has reached 2, gastrin begins to exert a negative feedback
to inhibit further acid secretion.
Intestinal phase
This begins when chyme (food mixed with gastric juices) enters the
duodenum, causing the secretion of three main gut hormones:
> Gastric inhibitory peptide (GIP), which inhibits further gastric secretions
and motility
> Secretin, which inhibits further gastric secretions
> Cholecystokinin (CCK), which inhibits stomach emptying.
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 GASTRIC REGULATION

Describe the function of these There are four main hormones involved: gastrin, GIP, secretin and CCK.
gut hormones.
Table 23.1  Functions of gut hormones

Hormone Release stimulated by: Actions

Gastrin Cephalic phase
Stomach distension
Proteins in stomach
↑ pH of chyme in stomach
GIP Fatty acids in small intestine
Secretin Acidic chyme in small
intestine
CCK Amino acids in small intestine
Fatty acids in small intestine
↑ Secretion of gastric juices
↑ Motility
Encourages growth of mucosa
Constricts LOS
Relaxes pyloric and ileocaecal sphincters
↑ Insulin release
Inhibits secretion of gastric juices
Slows gastric emptying
Stimulates contraction of gallbladder to release bile
Stimulates release of pancreatic enzymes
Augments effect of CCK
Stimulates contraction of gallbladder to release
bile
Stimulates release of pancreatic enzymes
Induces feeling of satiety
Inhibits gastric emptying
Enhances actions of secretin

Describe the sphincters present
in the gastrointestinal tract.
A sphincter is a structure, usually made up of circular muscle, that surrounds
the opening of a hollow organ or body and constricts to close it. Sphincters
can be anatomical, where they are clearly different from the surrounding
tissue, e.g. the anus, or functional where the histological distinction is not so
clear, e.g. lower oesophageal sphincter. Sphincters can be under voluntary
or involuntary control. There are many sphincters in the gastrointestinal tract:
> Upper oesophageal
> Lower oesophageal
> Pyloric
> Ileocaecal
> Sphincter of Oddi
> Anus
Upper oesophageal sphincter: This is at the level of the C5–6 vertebrae
and is made up of the cricopharyngeal part of the inferior pharyngeal
constrictor muscle. It is under conscious control and in its resting state it is
usually constricted to avoid air being drawn into the stomach during breathing.
Lower oesophageal sphincter (also called the ‘cardiac’ sphincter): This
is a functional sphincter, found at the junction between the non-keratinised
squamous epithelium of the oesophagus and the simple columnar epithelium
of the stomach. Its function is to prevent reflux of the acidic stomach
contents into the oesophagus and so it is constricted at rest and has a
pressure of 15–20 mmHg. The sphincter opens ahead of peristalsis during
the process of swallowing to allow food and fluid to enter the stomach. It is
supplied by the vagus nerve.
‘Barrier pressure’ describes the difference between LOS pressure
and intragastric pressure. The closer the barrier pressure is to zero, the
more likely it is that reflux will occur. So, reducing LOS tone or increasing
intragastric pressure (e.g. pregnancy, full stomach, abdominal distension)
makes reflux more likely.
Pyloric sphincter: This is an anatomical sphincter found at the junction of
the stomach and duodenum. Its ring of muscle relaxes to allow chyme to
pass out of the stomach. It is supplied by the coeliac ganglion.

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 01 PHYSIOLOGY
Ileocaecal sphincter: An anatomical sphincter found at the junction of the
small and large bowels. It prevents reflux of colonic material into the ileum.
Sphincter of Oddi: This is a ring of muscle that surrounds the bile and
pancreatic ducts as they emerge into the lumen of the duodenum about
halfway down its length. The sphincter controls the release of bile and
pancreatic enzymes into the duodenum.
Anus: The gastrointestinal tract ends in a pouch called the rectum,
where faeces are stored prior to defecation. At the exit of the rectum is the
anorectal junction, a voluntary sphincter that is made up of an internal and
an external ring of muscle. The internal anal sphincter is supplied by the
hypogastric plexus. It is involuntary and will relax in response to stretching.
The external anal sphincter is voluntary and supplied by the inferior
rectal nerves.
LOS Tone
by: by:
C5-6 UOS -
Cholinergic stimulation Cholinergic inhibition CRICOPHARYNGEUS
Histamine Dopamine
Gastrin Oestrogen SNS T5 - L3
Motilin CCK
Secretin

PNS S2, 3, 4 LOS 15-25 mmHg

Pyloric G cells
Gastrin

Acid secretion
by: by:
Food/brain/mouth/stomach FA/Glucose/AA in small intestine
Stress H2 receptor antagonists/PPI
Gastrin Vagotomy
Alcohol/Caffeine CCK, GIP/Secretin
Secretin

Oxyntic Glands
Chief cells Pepsinogen
Mucus cell Mucus
Gastrin, ACh, Histamine
stimulates Parietal cells H+
Gastric Emptying
by: by:
Cholinergic stimulation Food
Metoclopramide Stress, Pain etc.
Neostigmine Old age
Diabetes
Obstruction
Pregnancy
Opiods
Anticholinergics
Sympathomimetics
Alcohol

PNS Parasympathetic nervous system

SNS Sympathetic nervous system
UOS Upper oesophageal sphincter
LOS Lower oesophageal sphincter
FA Fatty acids
AA Amino acids
PPI Proton pump inhibitors
Fig. 23.2  Overview of gastric regulation

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