RELAXATION RESPONSES OF THE HUMAN PROXIMAL STOMACH TO DISTENSION DURING FASTING AND AFTER FOOD

The responses of the human proximal stomach to distension were studied in 22 healthy volunteers using an intragastric polyethylene bag, inflated progressively in 30-ml steps until the limit of tolerated volume was reached. Three successive inflations were carried out during the fasting state followed by a fourth inflation after ingestion of 250 ml of either a nutrient meal or isosmolar saline. The first inflation showed an initial nonlinear pressure rise (slope of logged pressure vs. volume = 114.6 +/- 10.0 log mmHg/ml x 10(-5)), which was then followed by the development of a plateau phase, in which further distension did not increase intragastric pressure. The slopes of the subsequent fasting inflations were significantly lower than that of the first inflation (P < 0.01) but were similar to each other (slope 83.0 +/- 5.4 and 79.8 +/- 5.7 log mmHg/ml x 10(-5)), indicating that distension-induced gastric relaxation had occurred. After saline ingestion, responses to distension were similar to those during the fasted state. After the nutrient meal ingestion, however, the slope decreased to 60.3 +/- 7.7 log mmHg/ml x 10(-5) CP < 0.01 vs. saline), indicating nutrient-induced gastric relaxation. Our study demonstrates that the pressure-volume characteristics of the proximal stomach are modulated both by distension and by the presence of nutrients in the upper gut, which appear to operate independently.