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Physiology of the Stomach

Physiology of the Stomach


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Fig 1.0 Overview of the stomach in the gastrointestinal tract

The stomach is a J shaped organ of the gastrointestinal tract, directly
inferior to the diaphragm. In the GI tract, it connects the oesophagus to
the duodenum.
Its position and size varies continuously, with the diaphragmpushing it
inferiorly during inspiration and pulling superiorly on expiration. The
stomach is very distensible to enable it to accommodate food, where the
digestion of starch, proteins and triglycerides begins.
In this article we will look at the physiological processes that occur in the
stomach, and any clinical correlations.
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Functions of the Stomach

As a GI organ, the stomach fulfills many functions, all associated with
the storage and digestion of food:
Mixes saliva, food and gastric juice to form
Reservoir for food before release into the small
Secretes gastric juice which can kill bacteria,
pepsin to digest proteins, intrinsic factor to absorb
vitamin B12 and lipase to digest triglycerides.
Secretes gastrin into blood.

Histology of the Stomach

The mucosa of the stomach consists of three main layers:
Epithelial layer The surface of the mucosa
consists of a layer of simple columnar epithelial
cells called surface mucous cells.
Lamina propria A layer of thin connective tissue.
Muscularis mucosae - A thin layer of smooth

Fig 1.1 The layers of the stomach wall.

In the mucosa, epithelial cells extend down into the lamina propria to
form gastric glands.
These glands secrete many important substances (see Gastric glands,
Underneath the mucosa lies the submucosa, muscularis externa, and
the serosa:
The submucosa is composed of areolar
connective tissue.

The muscularis externa has three layers of

smooth muscle; an outer longitudinal layer, a
middle circular layer and an inner oblique layer.

The serosa covering the stomach is composed of

simple squamous epithelium and areolar

connective tissue. It is fused with the visceral

peritoneum with overlays the stomach
At the lesser curvature of the stomach, the a double layer of peritoneum
extends upward to the liver as the lesser omentum. At the greater
curvature of the stomach, another double layer of peritoneum continues
downward as the greater omentum, draping over the intestines.

Gastric Glands

Fig 1.2 The exocrine cells of a gastric gland.

The gastric glands are, by definition, exocrine glands. They contain four
main cell types, each with a different secretion:
Mucous neck cells secrete mucus.
Parietal cells produce intrinsic factor and HCl.
Chief cells secrete pepsinogen and lipase.
G cells secrete gastrin.

Gastrin is arguably the most important secretion, influencing the majority

of the functions of the stomach.
Its functions include
Stimulate parietal cells to secrete HCl and chief
cells to secrete pepsinogen.
Contracts lower oesophageal sphincter.
Increases stomach motility.
Relaxes pyloric sphincter.

One of the major functions of the stomach is to begin the digestion of
food. Once the food bolus reaches the stomach, peristaltic waves
macerate the food, mixing it with gastric secretions to form a solution
known as chyme.

Fig 1. 3 The peristaltic ejection waves of the stomach

As digestion proceeds, more vigorous mixing waves begin in the body of
the stomach, with the waves intensifying in the pylorus.

The pyloric sphincter, which is normally closed, allows a small volume of

chyme to pass through into theduodenum.
Most of the chyme however is forced back into the stomach body for
further mixing. A further peristaltic wave forces the chyme towards the
pyloric sphincter.
Enzymatic digestion of proteins begins in the stomach. The main
enzyme involved is pepsin, secreted by chief cells. Pepsin breaks
peptide bonds between amino acids, breaking down a protein chain into
smaller peptide fragments. Pepsin is most effective an acidic
environment, which the stomach provides. This enzyme is secreted as
the inactive pepsinogen so as to prevent the digestion of proteins that
produce it.
Only a small amount of digested nutrients are absorbed in the stomach,
because its epithelial cells are relatively impermeable. Mucous cells
absorb some water, ions, alcohol and short chain fatty acids.

Gastric Acid Secretion in the Stomach

Maintaining an acidic environment is crucial to the proper functioning of
the stomach. Gastric acid is synthesised and secreted by the parietal
cells of the stomach.
The parietal cells have a unique structure. Canaliculi (invaginations of
the cell walll) are present on the lumenal surface of the cell. These
invaginations play a role in the secretion of gastric acid:
1. In the mitochondria of the parietal cell, water is
split into H+ and OH-

2. OH- combines with CO2 to form HCO3-, which

leaves the cell in exchange for a Cl- ion.
3. The H+ is pumped into the lumen of the gastric
gland by proton pumps on the canaliculi.
4. Cl- ions diffuse into the gastric lumen from the
parietal cell. They combine with H+ to from HCl.
The sight, smell and taste of food initiates reflexes that
stimulate parasympathetic neurons to release
acetylcholine. Acetylcholine and gastrin stimulate parietal cells to secrete
more HCl. They also cause the release of histamine, which acts
synergistically to enhance the effects of acetylcholine and gastrin.

Fig 1.4 Mechanism of gastric acid secretion from the parietal cells.

Clinical Relevance: Physiological Disorders of the


Stomach Ulcers

Fig 1.5 A peptic ulcer.

An ulcer is an erosion in the mucosal layer of the stomach .There are
two types of ulcer involving the stomach:
Gastric ulcers are lesions of the stomach mucosa.
Peptic ulcers are lesions of the mucosa of the
pyloric canal or duodenum.
Ulcers are often associated with the bacterium Helicobacter pylori.
Individuals with an ulcer generally have a high volume of gastric acid
secretion, which overwhelms thebicarbonate buffer and reduces the
protective nature of the mucous lining. H. pylori erodes the mucous lining
resulting in inflammation, rendering the mucosa vulnerable to gastric
acid and pepsin. If an ulcer erodes into the gastric arteries, it can cause
severe bleeding

Achlorhydria is a condition where gastric acid production is absent. It has
various causes, including hypothyroidism, H. pylori infection, and
autoimmune disorders.

As the stomach pH is no longer low, pepsin cannot work optimally. The

higher pH also fails to prevent bacterial replication, and pathogen
overgrowth is a common finding. Both these factors cause symptoms
similar to gastro-oesophagal reflux disease. Treatment focuses on
addressing the underlying cause