Factors modifying the frequency of spontaneous activity in gastric muscle

A Formal Approach for Scalable Simulation of Gastric ICC Electrophysiology

OBJECTIVE

Efficient and accurate organ models are crucial for closed-loop validation of implantable medical devices. This paper investigates bio-electric slow wave modeling of the stomach, so that gastric electrical stimulator (GES) can be validated and verified prior to implantation. In particular, we consider high-fidelity, scalable, and efficient modeling of the pacemaker, Interstitial cells of Cajal (ICC), based on the formal hybrid input output automata (HIOA) framework.

METHODS

Our work is founded in formal methods, a collection of mathematically sound techniques originating in computer science for the design and validation of safety-critical systems. We modeled each ICC cell using an HIOA. We also introduce an HIOA path model to capture the electrical propagation delay between cells in a network. The resultant network of ICC cells can simulate normal and diseased action potential propagation patterns, making it useful for device validation.

RESULTS

The simulated slow wave of a single ICC cell had high correlation ( ≈ 0.9) with the corresponding biophysical models.

CONCLUSIONS

The proposed model is able to simulate the slow wave activity of a network of ICC cells with high-fidelity for device validation.

SIGNIFICANCE

The proposed HIOA model is significantly more efficient than the corresponding biophysical models, scales to larger networks of ICC cells, and is capable of simulating varying propagation patterns. This has the potential to enable verification and validation of implantable GESs in closed-loop with gastrointestinal models in the future.

Recent advances in intestinal smooth muscle research: from muscle strips and single cells, via ICC networks to whole organ physiology and assessment of human gut motor dysfunction

Gastrointestinal smooth muscle research has evolved from studies on muscle strips to spatiotemporal mapping of whole organ motor and electrical activities. Decades of research on single muscle cells and small sections of isolated musculature from animal models has given us the groundwork for interpretation of human in vivo studies. Human gut motility studies have dramatically improved by high-resolution manometry and high-resolution electrophysiology. The details that emerge from spatiotemporal mapping of high-resolution data are now of such quality that hypotheses can be generated as to the physiology (in healthy subjects) and pathophysiology (in patients) of gastrointestinal (dys) motility. Such interpretation demands understanding of the musculature as a super-network of excitable cells (neurons, smooth muscle cells, other accessory cells) and oscillatory cells (the pacemaker interstitial cells of Cajal), for which mathematical modeling becomes essential. The developing deeper understanding of gastrointestinal motility will bring us soon to a level of precision in diagnosis of dysfunction that is far beyond what is currently available.

Convergence of inhibitory neural inputs regulate motor activity in the murine and monkey stomach

Inhibitory motor neurons regulate several gastric motility patterns including receptive relaxation, gastric peristaltic motor patterns, and pyloric sphincter opening. Nitric oxide (NO) and purines have been identified as likely candidates that mediate inhibitory neural responses. However, the contribution from each neurotransmitter has received little attention in the distal stomach. The aims of this study were to identify the roles played by NO and purines in inhibitory motor responses in the antrums of mice and monkeys. By using wild-type mice and mutants with genetically deleted neural nitric oxide synthase (Nos1^-/-) and P2Y1 receptors (P2ry1^-/-) we examined the roles of NO and purines in postjunctional inhibitory responses in the distal stomach and compared these responses to those in primate stomach. Activation of inhibitory motor nerves using electrical field stimulation (EFS) produced frequency-dependent inhibitory junction potentials (IJPs) that produced muscle relaxations in both species. Stimulation of inhibitory nerves during slow waves terminated pacemaker events and associated contractions. In Nos1^-/- mice IJPs and relaxations persisted whereas in P2ry1^-/- mice IJPs were absent but relaxations persisted. In the gastric antrum of the non-human primate model Macaca fascicularis, similar NO and purine neural components contributed to inhibition of gastric motor activity. These data support a role of convergent inhibitory neural responses in the regulation of gastric motor activity across diverse species.

Electrogastrography in adults and children: the strength, pitfalls, and clinical significance of the cutaneous recording of the gastric electrical activity

Cutaneous electrogastrography (EGG) is a non-invasive technique to record gastric myoelectrical activity from the abdominal surface. Although the recent rapid increase in the development of electrocardiography, EGG still suffers from several limitations. Currently, computer analysis of EGG provides few reliable parameters, such as frequency and the percentage of normal and altered slow wave activity (bradygastria and tachygastria). New EGG hardware and software, along with an appropriate arrangement of abdominal electrodes, could detect the coupling of the gastric slow wave from the EGG. At present, EGG does not diagnose a specific disease, but it puts in evidence stomach motor dysfunctions in different pathological conditions as gastroparesis and functional dyspepsia. Despite the current pitfalls of EGG, a multitasking diagnostic protocol could involve the EGG and the (13)C-breath testing for the evaluation of the gastric emptying time-along with validated gastrointestinal questionnaires and biochemical evaluations of the main gastrointestinal peptides-to identify dyspeptic subgroups. The present review tries to report the state of the art about the pathophysiological background of the gastric electrical activity, the recording and processing methodology of the EGG with particular attention to multichannel recording, and the possible clinical application of the EGG in adult and children.

Carbon dioxide-induced inhibition of mechanical activity in gastrointestinal smooth muscle preparations isolated from the guinea-pig

Mechanical responses of smooth muscle elicited by application of CO2-gas bubbled physiological salt solution (CO2-gas solution) were investigated in isolated stomach antrum and colon preparations of the guinea-pig. Circular smooth muscle preparations of both colon and stomach were spontaneously active with periodic generation of phasic contractions. In colonic preparations, the CO2-gas solution produced a biphasic response, with an initial small transient contraction followed by a sustained inhibition of phasic contractions. Removal of the CO2-gas solution allowed a slow recovery of the spontaneous contractions over a period of about 40 min. The recovery developed with a similar time course irrespective of the length of time exposed to CO2-gas solution. The inhibitory responses elicited by CO2-gas solution were not modulated by atropine, Nω-nitro-L-arginine or neostigmine. Atropine-sensitive excitatory responses of smooth muscle elicited by transmural nerve stimulation or exogenously applied acetylcholine were attenuated or abolished in the presence of CO2-gas solution. In stomach preparations, the CO2-gas solution elicited a tri-phasic response, with an initial transient relaxation followed by a transient contraction and then a sustained inhibition of the rhythmic contractions. The peak amplitude of the transient contraction was about 2.5 times larger than the spontaneous phasic contractions. The pH of the CO2-gas solution was reduced to about 6. Application of pH 6 solution again produced a tri-phasic response, as was the case for the CO2-gas solution, however the amplitude of the transient contraction was only about 0.4 times that of the spontaneous contractions. The re-appearance of the abolished phasic contraction was quicker with the pH 6 solution (about 1.8 min) than it was for the CO2-gas solution (about 6 min). The inhibitory responses elicited by the CO2-gas solution could be simulated only partly by the acidified solution, and a possible involvement of additional factors in the inhibition elicited by CO2-gas solution was considered.

Factors which determine the duration of follower potentials in longitudinal smooth muscle isolated from the guinea-pig stomach antrum

In isolated longitudinal muscle tissues of the guinea-pig stomach antrum, recording electrical responses from smooth muscle cells revealed a periodical generation of follower potentials with variable durations. The I-D relationship, made by plotting the duration as a function of the interval before generating follower potential, was linear. Experiments were carried out to investigate the effects of chemicals which had been known to modulate the release of Ca(2+) from the internal stores (2-aminoethoxy-diphenyl-borate, cyclopiazonic acid, caffeine), inhibit mitochondrial metabolic activity (m-chlorophenyl hydrazone, 2-deoxy-D-glucose, potassium cyanide, rotenone), inhibit ATP-sensitive K-channels distributed in mitochondria (glibenclamide, 5-hydroxydecanoic acid) and inhibit the activity of proteinkinase C (chelerythrine), on the I-D relationship of follower potentials. The effects of depolarization on follower potentials were assessed by stimulating tissues with high potassium solution. Experiments were carried out mainly in the presence of nifedipine which minimized the movements of muscles with no modulation of follower potentials. Cycropiazonic acid and caffeine reduced the slope of I-D relationship, with associated reduction of the duration and frequency of follower potentials. 2-Aminoethoxydiphenyl borate reduced the duration and amplitude and increased the frequency of follower potentials, with depolarization of the membrane, and the effects were simulated by high potassium solution. m-Chlorophenyl hydrazone, potassium cyanide, 2-deoxy-D-glucose, rotenone, 5-hydroxydecanoic acid and glibenclamide reduced the slope of I-D relationship, with associated reduction of the frequency of follower potentials. Chelerythrine did not modulate the slope of I-D relationship, with reduced frequency of follower potentials. It seemed likely that the amount of Ca(2+) released from the internal stores and also mitochondrial function had causal relationship to the duration of pacemaker potentials, suggesting that internal Ca-stores and mitochondria are taking the central role for determining the duration of the pacemaker activity. Proteinkinase C did not seem to participate to the function of mitochondria and internal Ca(2+) stores.

Generation and propagation of gastric slow waves

1. Mechanisms underlying the generation and propagation of gastrointestinal slow wave depolarizations have long been controversial. The present review aims to collate present knowledge on this subject with specific reference to slow waves in gastric smooth muscle. 2. At present, there is strong agreement that interstitial cells of Cajal (ICC) are the pacemaker cells that generate slow waves. What has been less clear is the relative role of primary types of ICC, including the network in the myenteric plexus (ICC-MY) and the intramuscular network (ICC-IM). It is concluded that both ICC-MY and ICC-IM are likely to serve a major role in slow wave generation and propagation. 3. There has been long-standing controversy as to how slow waves 'propagate' circumferentially and down the gastrointestinal tract. Two mechanisms have been proposed, one being action potential (AP)-like conduction and the other phase wave-based 'propagation' resulting from an interaction of coupled oscillators. Studies made on single bundle gastric strips indicate that both mechanisms apply with relative dominance depending on conditions; the phase wave mechanism is dominant under circumstances of rhythmically generating slow waves and the AP-like propagation is dominant when the system is perturbed. 4. The phase wave mechanism (termed Ca(2+) phase wave) uses cyclical Ca(2+) release as the oscillator, with coupling between oscillators mediated by several factors, including: (i) store-induced depolarization; (ii) resultant electrical current flow/depolarization through the pacemaker cell network; and (iii) depolarization-induced increase in excitability of downstream Ca(2+) stores. An analogy is provided by pendulums in an array coupled together by a network of springs. These, when randomly activated, entrain to swing at the same frequency but with a relative delay along the row giving the impression of a propagating wave. 5. The AP-like mechanism (termed voltage-accelerated Ca(2+) wave) propagates sequentially like a conducting AP. However, it is different in that it depends on regenerative store Ca(2+) release and resultant depolarization rather than regenerative activation of voltage-dependent channels in the cell membrane. 6. The applicability of these mechanisms to describing propagation in large intact gastrointestinal tissues, where voltage-dependent Ca(2+) entry is also likely to be functional, is discussed.

Hypoxia differentially modulates the activity of pacemaker and smooth muscle cells in the guinea pig stomach antrum

Effects of hypoxic solution (O(2) tension, 161 +/- 11 mmHg) on electrical responses of the membrane (slow waves), intracellular Ca(2+)-responses measured by Fura-2 fluorescence (Ca-transients) and isometric mechanical responses (phasic contraction) were observed in circular smooth muscles isolated from the guinea-pig stomach antrum. In normoxic solution (O(2) tension, 362 +/- 28 mmHg), muscle cells generated slow waves spontaneously, and switching to hypoxic solution caused an increase in frequency and decrease in duration of slow waves, with no significant change in the resting membrane potential. Hypoxia also reduced the amplitude and duration and increased the frequency of Ca-transients. The increase in frequency of slow waves by hypoxia was prevented by cyclopiazonic acid (CPA) but not by carbonyl cyanide m-chlorophenyl-hydrazone (CCCP), potassium cyanide (KCN) or low-Ca solution. The reduction by hypoxia of the duration of slow waves was prevented by CCCP or KCN but not by CPA or low-Ca solution. Hypoxia resulted in an increase in frequency and decrease in amplitude of phasic contractions, and the changes were prevented by CPA but not by CCCP. These results suggested that in antrum smooth muscle tissues, the increase in frequency of spontaneous activity by hypoxia is related to the enhanced function of the CPA-sensitive internal Ca-stores in pacemaker cells, while the inhibition in amplitude of phasic contractions by hypoxia may be mainly related to the decrease in Ca(2+) release from the CPA-sensitive internal stores in smooth muscle cells. It is concluded that in hypoxic solution, the function of internal Ca(2+) stores is enhanced in ICC-MY and is inhibited in smooth muscle cells in the guinea-pig stomach antrum.

Regional differences in the frequency of slow waves in smooth muscle of the guinea-pig stomach

The frequency of slow waves recorded from circular muscle bundles with attached longitudinal muscle (intact muscle) was compared with that of slow potentials recorded from isolated circular muscle bundles (isolated muscle) from the guinea-pig stomach. In intact muscle preparations, slow waves were generated in the corpus, antrum and pylorus with a higher frequency in the corpus (about 5 min(-1)) than the other regions (about 2 min(-1) in antrum, about 1.5 min(-1) in pylorus). The resting potential amplitude was graded across the stomach, at about -50 mV in the fundus, -60 mV in the corpus, -65 mV in the antrum and -70 mV in the pylorus. A similar distribution of resting membrane potential and slow potential frequency was also observed in isolated muscle bundles from the different regions. Caffeine (1 mM) abolished slow waves in some corpus preparations and inhibited the 2nd component of slow waves in the antrum and pylorus, and also abolished slow potentials in isolated muscle preparations from any region of the stomach. This suggests that myenteric interstitial cells of Cajal (ICC-MY) are heterogeneously distributed in the stomach (pylorus, antrum and part of the corpus regions), with a homogeneous distribution of muscular interstitial cells of Cajal (ICC-IM) within the circular muscle bundles. The frequency of slow potentials in smooth muscle isolated from any region of the stomach changed linearly in response to membrane potential changes produced by either current injection or high potassium solutions. The frequency of slow potentials after setting the membrane potential at -60 mV was larger in the corpus than the antrum, suggesting that the high frequency discharge of corpus muscle is produced by the low membrane potential and additional unidentified factors. We suggest that the regional difference in slow wave discharge is produced mainly by ICC-IM, and the role of ICC-MY may be little, if any.

Expression of metabotropic glutamate receptors mGluR1 and mGluR5 in the myenteric plexus of the diabetic rat ileum

AIM: To find the morphologic abnormalities, if any, of myenteric plexus in diabetic rats, to explore the expressive alteration of the Group Ⅰ mGluRs (mGluR1, mGluR5) and to explore the role of glutamic acid energic nerve in enteric nervous system of diabetic gastroenteropathy.

METHODS: Forty rats were randomly divided into diabetic group and control group. Gastric emptying and small intestine transit rate were measured, and the number of mGluR1 and mGluR5 receptors in diabetic rats was studied using fluorescence immunohistochemistry and RT-PCR.

RESULTS: Eighteen weeks after the establishment of the diabetic rats model, gastric emptying and gastrointestinal transit rate were delayed compared with control group. The number of ganglia and neurons was significantly decreased in diabetic rats compared with control group (mGluR1: 4.5 ± 3.1 vs 7.3 ± 2.4, 142.25 ± 28.24 vs 175.34 ± 34.83, both P < 0.05; mGluR5: 4.3 ± 2.1 vs 7.9 ± 2.8, 133.37 ± 35.73 vs 168.34 ± 32.66, both P < 0.05). The fluorescence intensity of the receptors of mGluR1 and mGluR5 in the diabetic rats was weakened compared with control group (mGluR1: 145.23 ± 28.78 vs 167.72 ± 30.56, both P < 0.05; mGluR5: 141.54 ± 18.46 vs 172.53 ± 29.74, both P < 0.05), and mGluR1 and mGluR5 mRNA expressions were decreased in the diabetic rats (1.05 ± 0.27 vs 1.43 ± 0.47, 0.95 ± 0.30 vs 1.60 ± 0.39, both P < 0.01).

CONCLUSION: Decreased glutamatergic ganglia and neurons and reduced receptor expression of mGluR1 and mGluR5 in myenteric plexus might be one of the mechanisms of diabetic gastroenteropathy in rats.

Cellular mechanism of the voltage-dependent change in slow potentials generated in circular smooth muscle of the guinea-pig gastric corpus

The cellular mechanism of the voltage-dependent properties of slow potentials were investigated in single bundles of circular smooth muscle isolated from the gastric corpus of guinea-pig using conventional microelectrode recordings. Hyperpolarization of the membrane by current injection decreased the frequency and increased the amplitude of slow potentials linearly. At potentials negative of -80 mV, slow potential generation was abolished and a periodic generation of clustered unitary potentials was evident. Application of cyclopiazonic acid (CPA, 20 microM) or thapsigargin (1 microM; inhibitors of Ca(2+)-ATPase), carbonyl cyanide m-chlorophenyl hydrazone (CCCP, 0.1 microM; mitochondrial protonophore) or 2-aminoethoxydiphenyl borate (2-APB, 20 microM; inhibitor of IP(3) receptor-mediated Ca(2+) release) depolarized the membrane and reduced or inhibited the amplitude and frequency of slow potentials: repolarization of the membrane to the resting level by current injection resulted in a recovery of the amplitude of slow potentials in the presence of CPA or CCCP, but not 2-APB. The slow potentials abolished by thapsigargin did not recover upon membrane repolarization. The altered frequency of slow potentials by 2-APB, CPA or CCCP was not reversed by membrane repolarization to control potentials. Depolarization of the membrane by about 10 mV with high-potassium solution also reduced the amplitude and increased the frequency of slow potentials in a manner restored by repolarization to control potentials upon current injection, suggesting that membrane depolarization did not affect the voltage dependency of pacemaker activity. The results indicate that in corpus circular muscles the voltage dependency of the frequency and amplitude of slow potentials requires a functional Ca(2+) store and mitochondria.

Mathematical model to simulate the extracellular myoelectrical activity of the cat colon

The rationale of this study was to investigate if the bases of generation of the electrical activity of the whole gut are the same. For this reason, we developed a mathematical dipole model, based on the same foundations used to simulate the electrical activity of the human stomach, to generate the electrical activity of the transverse cat colon. The model developed takes into account both the geometry of the transverse colon represented by a cylinder of finite length and the myoelectrical dynamics of the cells. The extracellular electrical activity was simulated by the periodic movement of an annular band polarised by electric dipoles. The simulation not only reproduces both the waveform, amplitude, phase lag and frequency of the ECA and the frequency, duration and periodicity of the ERA but also allows us to reproduce both increases/decreases of frequency, the inversion of phase conditions of the ECA and ERA, and to underline the anatomical and physiological parameters that can modify the ECA amplitude, such as the radius of the colon and the cells' dipole moment density. The simulation also picks up not only the effects of the probes' type (unipolar, bipolar, endoluminal, external) and of their positioning during in vivo experiments made by implanted electrodes to record the ECA and ERA, but also allows us to find both the theoretical best configuration for the surface electrodes and the effects of the distance between the abdominal electrodes and the source of the electrical activity, and of the distance between the electrodes.

Mechanical and electrical responses modulated by excitation of inhibitory nerves during stimulation with high-potassium solutions in circular smooth muscle of the rabbit rectum

The properties of the mechanical responses produced by solutions containing high concentrations of potassium ion (high-K solution, [K(+)](o) = 9-27 mM) were investigated in circular smooth muscle preparations isolated from the rabbit rectum. Isometric recording of mechanical responses of the muscle revealed spontaneous contractions, which successively decreased and finally disappeared in most preparations. Stimulation of the smooth muscle with high-K solutions elicited an increase in both amplitude and frequency of twitch contractions (sustained component), with about a 2 min delay in the beginning (initial inhibition), and a transient large contraction shortly after the cessation of stimulation (after contraction). Transmural nerve stimulation (TNS) with electrical pulses for 1 min at 1 Hz frequency produced a sustained inhibition, but a transient contraction followed after termination of TNS. In the presence of tetrodotoxin (TTX), the TNS-induced responses were abolished, while a high-K solution elicited increased twitch contractions with a short delay and abolished the after contraction. Suramin produced effects similar to TTX on the responses produced by high-K solutions or TNS, but this was not the case for atropine, guanethidine or N(omega)-nitro-L-arginine (L-NA). Recording membrane potentials with microelectrodes revealed that TNS evoked an inhibitory junction potential (i.j.p.) which was non-adrenergic, non-cholinergic and non-nitrergic in nature. High-K solutions elicited a tri-phasic change in the membrane potential; an initial hyperpolarization, followed by a sustained depolarization and finally a transient depolarization on cessation of high-K stimulation. TTX or suramin inhibited the i.j.p.s and altered the tri-phasic change in the membrane potential produced by a high-K solution to a mono-phasic depolarization. No significant modulation of electrical responses of the membrane induced by TNS or high-K solution was elicited by atropine, guanethidine or L-NA. The results indicated that the circular smooth muscle of the rabbit rectum is innervated by inhibitory nerves, and that stimulation with high-K solutions caused inhibitory neuronal modulation of both electrical and mechanical responses of the smooth muscle, in a suramin-sensitive way.

Role of mitochondria in spontaneous rhythmic activity and intracellular calcium waves in the guinea pig gallbladder smooth muscle

Mitochondrial Ca(2+) handling has been implicated in spontaneous rhythmic activity in smooth muscle and interstitial cells of Cajal. In this investigation we evaluated the effect of mitochondrial inhibitors on spontaneous action potentials (APs), Ca(2+) flashes, and Ca(2+) waves in gallbladder smooth muscle (GBSM). Disruption of the mitochondrial membrane potential with carbonyl cyanide 3-chlorophenylhydrazone, carbonyl cyanide 4-(trifluoromethoxy) phenylhydrazone, rotenone, and antimycin A significantly reduced or eliminated APs, Ca(2+) flashes, and Ca(2+) waves in GBSM. Blockade of ATP production with oligomycin did not alter APs or Ca(2+) flashes but significantly reduced Ca(2+) wave frequency. Inhibition of mitochondrial Ca(2+) uptake and Ca(2+) release with Ru360 and CGP-37157, respectively, reduced the frequency of Ca(2+) flashes and Ca(2+) waves in GBSM. Similar to oligomycin, cyclosporin A did not alter AP and Ca(2+) flash frequency but significantly reduced Ca(2+) wave activity. These data suggest that mitochondrial Ca(2+) handling is necessary for the generation of spontaneous electrical activity and may therefore play an important role in gallbladder tone and motility.

Calcium-associated mechanisms in gut pacemaker activity

A considerable body of evidence has revealed that interstitial cells of Cajal (ICC), identified with c-Kit-immunoreactivity, act as gut pacemaker cells, with spontaneous Ca²⁺ activity in ICC as the probable primary mechanism. Namely, intracellular (cytosolic) Ca²⁺ oscillations in ICC periodically activate plasmalemmal Ca²⁺-dependent ion channels and thereby generate pacemaker potentials. This review will, thus, focus on Ca²⁺-associated mechanisms in ICC in the gastrointestinal (GI) tract, including auxiliary organs.

Origin and propagation of individual slow waves along the intact feline small intestine

The pattern of propagation of slow waves in the small intestine is not clear. Specifically, it is not known whether propagation is determined by a single dominant ICC-MP (Interstitial cells of Cajal located in the Myenteric Plexus) pacemaker unit or whether there are multiple active pacemakers. To determine this pattern of propagation, waveforms were recorded simultaneously from 240 electrodes distributed along the whole length of the intact isolated feline small intestine. After the experiments, the propagation patterns of successive individual slow waves were analysed. In the intact small intestine, there was only a single slow wave pacemaker unit active, and this was located at or 6-10 cm from the pyloric junction. From this site, slow waves propagated in the aboral direction at gradually decreasing velocities. The majority of slow waves (73%) reached the ileocaecal junction while the remaining waves were blocked. Ligation of the intestine at one to four locations led to: (a) decrease in the distal frequencies; (b) disappearance of distal propagation blocks; (c) increase in velocities; (d) emergence of multiple and unstable pacemaker sites; and (e) propagation from these sites in the aboral and oral directions. In conclusion, in the quiescent feline small intestine a single pacemaker unit dominates the organ, with occasional propagation blocks of the slow waves, thereby producing the well-known frequency gradient.

Gastric motility

PURPOSE OF REVIEW

This review focuses on progress made in the field of gastric motility in the past year, emphasizing advances in understanding the motor physiology of the stomach in health and disease; noninvasive imaging technology and data on novel pharmacotherapeutics and other therapeutic interventions for gastroparesis.

RECENT FINDINGS

The differential conduction pattern in the interstitial cell of Cajal is responsible for the generation of the full spatio-temporal pattern of gastric peristalsis. The mitochondrial powerhouse provides the driving potential for the gastric slow waves. Females are more dependent on the nitrenergic system for gastric relaxation, which is predominantly affected in diabetes. The noninvasive modalities to evaluate gastric function have undergone substantial evolution in the past year. On the therapeutic front, a new generation of medications has been tested and holds promise for the near future. Gastric electrical stimulation is a viable option for medically refractory gastroparesis.

SUMMARY

Using dynamic imaging modalities, the pathophysiology of dyspepsia is becoming better understood and recognized as an end point of multifactorial dysfunction of the enteric neural circuitry. Mechanism-targeted drugs, stem cell transplantation and electrical stimulation options are becoming available.

Electrical events underlying organized myogenic contractions of the guinea pig stomach

The stomach generates a characteristic pattern of coordinated activity whereby rings of contraction regularly start in the corpus and migrate slowly down the stomach to the duodenum. This behaviour persists after isolating the stomach and after blocking nervous activity; hence the response is myogenic, resulting from organized contractions of smooth muscle cells lying in the stomach wall. Each ring of contraction is triggered by a long lasting wave of depolarization, termed a slow wave. Slow waves are now known to be generated by sets of interstitial cells of Cajal (ICC), which intermingle with gastric smooth muscle cells. This article describes some studies which identify the roles played by ICC in the on-going generation of coordinated gastric movements. Intramuscular ICC in the corpus generate slow waves and these provide the dominant pacemaker frequency in the stomach. Corporal slow waves, in turn, activate a network of myenteric ICC, which starts in the antrum and slowly conducts waves of depolarization down the stomach. As these waves pass over bundles of circularly orientated muscle cells, they activate a set of intramuscular ICC which lie in the circular muscle layer: these generate slow waves that rapidly spread radially, so triggering each ring of contraction.