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Gastric sensitivity and reflexes: basic mechanisms underlying clinical problems

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Abstract

Both reflex and sensory mechanisms control the function of the stomach, and disturbances in these mechanisms may explain the pathophysiology of disorders of gastric function. The objective of this report is to perform a literature-based critical analysis of new, relevant or conflicting information on gastric sensitivity and reflexes, with particular emphasis on the comprehensive integration of basic and clinical research data. The stomach exerts both phasic and tonic muscular (contractile and relaxatory) activity. Gastric tone determines the capacity of the stomach and mediates both gastric accommodation to a meal as well as gastric emptying, by partial relaxation or progressive recontraction, respectively. Perception and reflex afferent pathways from the stomach are activated independently by specific stimuli, suggesting that the terminal nerve endings operate as specialized receptors. Particularly, perception appears to be related to stimulation of tension receptors, while the existence of volume receptors in the stomach is uncertain. Reliable techniques have been developed to measure gastric perception and reflexes both in experimental and clinical conditions, and have facilitated the identification of abnormal responses in patients with gastric disorders. Gastroparesis is characterised by impaired gastric tone and contractility, whereas patients with functional dyspepsia have impaired accommodation, associated with antral distention and increased gastric sensitivity. An integrated view of fragmented knowledge allows the design of pathophysiological models in an attempt to explain disorders of gastric function, and may facilitate the development of mechanistically orientated treatments.

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Acknowledgments

The authors thank Gloria Santaliestra for secretarial assistance. Jan Tack is supported by a Methusalem grant from Leuven University. Supported in part by the Spanish Ministry of Education (Dirección General de Investigación, SAF 2009-07416). Ciberehd is funded by the Instituto de Salud Carlos III. CFB acknowledges support by a National Health and Medical Research Council of Australia Senior Research Fellowship (grant no 627002, 2010–2014).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Digestive System Research Unit, Hospital General Vall d’Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), 08035, Barcelona, Spain

    Fernando Azpiroz

  2. Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain

    Fernando Azpiroz

  3. Discipline of Medicine and National Health and Medical Research Council of Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia

    Christine Feinle-Bisset

  4. Department of Biomedical Science, The University of Sheffield, Sheffield, UK

    David Grundy

  5. Translational Research Center for Gastrointestinal Disorders (TARGID), Catholic University of Leuven, Louvain, Belgium

    Jan Tack

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  1. Fernando Azpiroz
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  4. Jan Tack
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Correspondence to Fernando Azpiroz.

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Azpiroz, F., Feinle-Bisset, C., Grundy, D. et al. Gastric sensitivity and reflexes: basic mechanisms underlying clinical problems. J Gastroenterol 49, 206–218 (2014). https://doi.org/10.1007/s00535-013-0917-8

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  • DOI: https://doi.org/10.1007/s00535-013-0917-8

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