Digestive System Research Unit, Hospital General Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), 08035, Barcelona, Spain,
J Gastroenterol. 2014 Feb;49(2):206-18. doi: 10.1007/s00535-013-0917-8. Epub 2013 Dec 4.
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.
反射和感觉机制均控制着胃的功能，这些机制的紊乱可能解释了胃功能障碍的病理生理学。本报告的目的是对胃敏感性和反射的新的、相关的或有冲突的信息进行基于文献的批判性分析，特别强调对基础和临床研究数据的综合整合。胃会产生时相性和紧张性（收缩性和松弛性）的肌肉活动。胃张力决定了胃的容量，并通过部分松弛或逐渐再收缩分别介导胃的适应性和排空。来自胃的感知和反射传入途径可被特定刺激独立激活，这表明末端神经末梢作为专门的受体起作用。特别是，感知似乎与张力感受器的刺激有关，而胃中是否存在容积感受器尚不确定。已开发出可靠的技术来测量胃的感知和反射，无论是在实验还是临床条件下，这有助于识别胃疾病患者的异常反应。胃轻瘫的特征是胃张力和收缩性受损，而功能性消化不良患者的适应性受损，与胃窦扩张和胃敏感性增加有关。对零碎知识的综合看法允许设计病理生理学模型，以试图解释胃功能障碍，并可能有助于开发以机械为导向的治疗方法。
