Duodenum as a immediate brake to gastric outflow: a videofluoroscopic and manometric assessment.
OBJECTIVE
Duodenal infusion of HCl or lipid delays gastric emptying. The aim of this study was to assess whether this delay was in part caused by mechanical activity of the duodenum.


METHODS
Synchronized videofluoroscopy and manometry was used in 8 volunteers (5 men and 3 women) to examine contractile and flow patterns during duodenal infusion of 0.9% NaCl, HCl, 5% NaCl, bile, and sodium oleate, each mixed with 20% (wt/vol) barium sulfate.


RESULTS
Within 15-30 seconds of infusion, HCl and 5% NaCl induced frequent large-amplitude contractions greater tha those induced by 0.9% NaCl. Initially, there was rapid dispersion of HCl followed by prolonged, tonic occlusion of the duodenum. The duodenal diameter decreased compared with that observed during 0.9% NaCl or oleate infusion. In contrast, after infusion of oleate or bile, duodenal diameter increased and there were fewer, smaller-amplitude, nonpropagating contractions with prolonged retention of solutions. Barium (20%; wt/vol) did not influence the motility index of any solution.


CONCLUSIONS
HCl and 5% NaCl may restrict gastric outflow by inducing tonic occlusion of the duodenum, whereas bile and lipid may delay clearance by decreasing duodenal tone and contractility. Thus, the duodenum may serve as an immediate brake to gastric outflow either by delaying clearance or by offering rapid tonic resistance.
Rao
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Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, USA.
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Schulze-Delrieu
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D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001466:Barium Sulfate / Q000494:pharmacology; D001646:Bile / Q000502:physiology; D003287:Contrast Media / Q000494:pharmacology; D004386:Duodenum / Q000187:drug effects / Q000502:physiology*; D005260:Female; D005471:Fluoroscopy; D005746:Gastric Emptying / Q000187:drug effects / Q000502:physiology*; D005769:Gastrointestinal Motility / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D006851:Hydrochloric Acid / Q000494:pharmacology; D008297:Male; D008365:Manometry; D019301:Oleic Acid; D009829:Oleic Acids / Q000494:pharmacology; D012965:Sodium Chloride / Q000494:pharmacology; D014741:Video Recording
D003287:Contrast Media; D009829:Oleic Acids; D001466:Barium Sulfate; D019301:Oleic Acid; C013173:osteum; D012965:Sodium Chloride; D006851:Hydrochloric Acid