The Metabolic Gradient Underlying Peristalsis

Abstract

Why sometimes does it turn around and come back through the mouth? These questions are fundamental; and the future of gastro-enterology as an exact science depends on the fulness with which they are answered. Until we obtain such physiologic knowledge we must face the fact that in practice we are trying to repair a machine, the normal structure and workings of which are largely unknown to us. Naturally the results are often unsatisfactory, just as they would be if we were trying to repair brokendown adding machines or wireless telephones.What could the heart specialist learn about the arrhythmias until Gaskell, McWilliam, His, Keith, Lewis and others showed him where the beat normally arises and how it is transmitted from sinus to ventricle? Given that information, the student of heart pathology became inspired and rejuvenated; his knowledge advanced by leaps and bounds ; and his textbooks had to be rewritten and remodeled. We should take hope from this good fortune which has come to our confrères and should seize on the methods of study which have been so productive in their bands. With these I believe we can advance to similar triumphs over the baffling problems in our own chosen field. We should study the gastro-intes¬ tinal tract in embryos and in lower and simpler forms of life; we should look for structural and metabolic differences in the neuromuscular apparatus in different parts of the tract, and we should study minutely the reactions of the muscular coat-its rhythmicity, irritability, conductivity, reaction to drugs, etc.-in different regions. As clinicians, we must get over the habit of thinking in terms of plumbing and rigid tubes held in one position. We must think instead of a muscular tube which has to contract in a coordinated way if material within it is to be pushed for many feet in one direction or the other.Six years ago I showed that there is a very definite gradient of rhythmicity in the muscle of the small intestine from duodenum to ileum1. It seemed to me then that this gradient of rhythmicity or perhaps some underlying gradient of tone might be the essential factor in determining the direction of peristalsis. This gradient might conceivedly be reversed by any distention, irritation or inflammation which would increase the tone and activity of the lower parts of the tract to a level above that maintained by the upper parts. In two papers2 I reviewed much of the litera¬ ture and showed how easily a great many clinical and roentgenologic observations can be explained on the basis of such a theory.I cannot see now why there should be any great difficulty in accepting this idea of a gradient of forces as a working hypothesis in the study of peristalsis. Wherever we find movement in this world we find a gradation of forces. Thus, water flowing in a ditch follows a gradient of gravity, i. e., the pressure on any one drop is greater on the upstream than on the downstream side. Electricity in a wire follows a gradient of potential or voltage ; in a battery it follows a gradient of chemical activit...

The Effects of Transections on the Basic Electrical Rhythm in the Canine Jejunum

“…The existence of a decreasing BER frequency gra dient is well established since the studies of A lvarez and Starkweather [1]. R inecker and Brendel [15] reported a similar frequency gradient of rhythmic contractions.…”