Regulation of Gastric Secretion

By Dr Nikhil Bhavsar Department of Physiology SRM MCH & RC.

Introduction : 1) Stimuli altering Gastric Secretion - Stimulating factors and their action - Inhibiting factors and their action 2) Regulation. 3) Phases of Gastric Juice Secretion.

Stimuli altering Gastric Acid Secretion A. Factors increasing HCL secretion Luminal Factors 1) Distention of stomach. 2) Products of protein digestion Hormonal Factors 1) Acetylcholine 2) Gastrin 3) Histamine Neural Factors 1) Vagal stimulation (cholinergic & noncholinergic) Blood Borne 1) Epinephrine 2) Gastrin

B. Factors that decrease HCL secretion

Luminal Factors 1) Increased acid content (highly acidic chyme)

Hormonal Factors 1) Somatostatin Blood borne Factors 1) Secretin, Gastric Inhibitory Peptide(GIP), Vasoactive Intestinal polypeptide(VIP), Glucagon

Mechanism of action Of hormones on parietal Cells.

Action of Stimulating factors is mainly through -Acetylcholine -Gastrin -Histamine Acetylcholine Released at nerve endings of vagal cholinergic fibres Acts on M3 cholinergic receptors Direct action on parietal cell to increase HCL secretion Indirect action on Enterchromafinlike (ECL) and G cells causes secretion of histamine and gastrin respectively

Gastrin -Most potent stimulator -Non cholinergic fibres of vagus release neurotransmitter Gastrin Releasing peptide (GRP) -It stimulates G cells present in antral mucosa -Causing release of Gastrin -Which acts on Gastrin Receptor on Parietal cells -Increasing intracellular Ca++ levels -leading to stimulation of H+K+ ATPase pump -Gastrin also causes release of Histamine from ECL cells.

Histamine Acts on Histamine type 2 receptor on parietal cells Released by ECL cells Both acetylcholine and gastrin stimulate its release Mechanical and Chemical factors Stretching of G cells causes gastrin release Peptides and Amino Acids increase gastrin release

Action of Inhibiting factors -pH of gastric luminal content - somatostatin - chyme in duodenum pH of Gastric luminal content By negative feed back via G cells and D cells Which causes inhibition of gastrin secretion and stimulation of somatostatin secretion Somatostatin Secreted from D cells of gastric mucosa, when pH less than 2 It inhibits Gastrin release Chyme in Duodenum Acidic chyme causes release of Secretin from upper intestinal mucosa. It inhibits Gastrin release. Products of carbohydrate and lipid digestion cause release of Gastric inhibitory peptide (GIP) , which also inhibits secretion.

Regulation of Gastric Juice Secretion occurs by 2 mechanisms Neural mechanisms Hormonal mechanisms

Neural Mechanisms are Parasympathetic and Sympathetic influences Short and long Gastro Intestinal Reflexes Central influences mediated via Vagus

Hormonal Mechanisms

As discussed above.

Phases of Gastric Secretion 1) CEPHALIC PHASE 2) GASTRIC PHASE 3) INTESTINAL PHASE

Cephalic Phase
Stimuli : Smell, sight, thought, taste and chewing of food. Via Unconditioned and Conditioned reflexes Secretion occurs before food reaches stomach and stimulates appetite so its called Appetite Juice Accounts for 20% of total gastric secretion

Experimental design to study Cephalic Phase

-SHAM FEEDING AND PAVLOVS POUCH

GASTRIC PHASE

Stimulus food distending the stomach, also products of digestion like peptides and amino acids. Initiates both central and local reflexes Central reflex Via vagus (vagovagal reflex) , is both cholinergic and non non cholinergic

Local Myenteric reflex -Stimulation of myenteric plexus in stomach wall. -Release of Acetylcholine, stimulates parietal cell

Stretching , Peptides and Amino Acids cause release of gastrin from G cells. Accounts for 70% of gastric secretion

Experimental design to Study Gastric Phase

Studied by making 5 types of pouches 1) Pavlovs Pouch

Small part of stomach incompletely separated from stomach and made into a pouch. Intact nerve supply and blood supply

2) Heidenhain Pouch Modified pavlov's pouch, pouch is completely separated from stomach. Parasympathetic nerve supply absent Sympathetic supply and blood supply is intact To demonstrate effect of local hormones and sympathetic nerves. 3) Bickel Pouch Totally denervated, and without blood supply To demonstrate role of local hormones. 4) Farrel and Ivy Pouch Complete transplantation for Bickel Pouch to subcutaneous tissue of abdominal wall or thoracic wall in the same animal. To demonstrate the role of local hormones.

INTESTINAL PHASE

Initial stage is stimulatory

- chyme stimulates duodenal mucosa to release gastrin, and entero-oxynthin from upper jejunum - these are transported via blood and stimulate gastric secretion

Later stage is inhibitory

- acidic chyme inhibits gastric secretion via Entero-gastric reflex - stimulates release of secretin which inhibits G cells - secretion of Bulbogastrone from duodenal mucosa which is inhibits parietal cells - products of fat digestion stimulate secretionof GIP and CCK (cholecystokinin) from upper part of small intestine, inturn inhibit parietal cells. - Net effect is inhibition and this phase accounts for 10% of gastric secretions

In Summary

Factors Stimulating and Inhibiting the Gastric Secretion Mechanism of action of Hormones Regulation of Gastric Juice Secretion

. 3 Phases of Gastric Secretion & Experimental Designs to Study them.

REFERENCES

Textbook of Medical Physiology Bern and Levy Physiology

- G.K.Pal

Essentials of medical physiology

Textbook of Medical Physiology

- K Sembulingam
- Guyton & Hall

Ganongs review of Medical Physiology

Thank You