Physiology of gastric acid secretion
- Nimish B Vakil, MD, AGAF, FACP, FACG, FASGE
Nimish B Vakil, MD, AGAF, FACP, FACG, FASGE
- Clinical Professor of Medicine
- University of Wisconsin School of Medicine and Public Health
The regulation of acid and pepsin secretion reflects an intricate balance of chemotransmitters delivered to the gastric mucosa by several pathways that mediate both stimulatory and inhibitory mechanisms . Similarly, several mechanisms contribute to the remarkable ability of normal gastroduodenal mucosa to defend itself against injury from the acid/peptic activity in gastric juice and to rapidly repair injury when it does occur. Secretory, defense, and healing mechanisms are regulated by the same type of overlapping neural, endocrine, paracrine, and autocrine control pathways.
Gastric acid facilitates the digestion of protein and the absorption of iron, calcium, vitamin B12, and is necessary for the absorption of some drugs such as ketoconazole, itraconazole, and thyroid hormone . Gastric acid, by lowering pH, kills ingested microorganisms and limits bacterial growth in the stomach and prevents intestinal infections such as Clostridium difficile. In addition, gastric acid may have a role in preventing spontaneous bacterial peritonitis [3-5].
FUNCTIONAL ANATOMY OF THE STOMACH
The stomach consists of three anatomical (fundus, corpus, and antrum) and two functional areas (oxyntic and pyloric glands). The oxyntic area comprises approximately 80 percent of the stomach and contains parietal cells that produce gastric acid. Also present in the oxyntic glands are neuroendocrine cells producing paracrine and hormonal agents that modify parietal cell activity. The antrum of the stomach contains pyloric glands and their main feature is the presence of gastrin secreting G cells. Somatostatin secreting D cells are present in the pyloric and oxyntic glands and modulate gastrin release .
PHASES OF ACID SECRETION
The physiologic stimulation of acid secretion has classically been divided into three interrelated phases: cephalic, gastric, and intestinal .
●The cephalic phase is activated by the thought, taste, smell, and sight of food, and swallowing. It is mediated mostly by cholinergic/vagal mechanisms.
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- FUNCTIONAL ANATOMY OF THE STOMACH
- PHASES OF ACID SECRETION
- SECRETION OF ACID AND PEPSIN
- The parietal cell
- - Gastrin receptors
- - Regulation of gastrin secretion
- Neural control
- Other secretory regulators
- MEASURING ACID SECRETION IN HUMANS
- Tolerance and acid rebound
- - Mechanisms of rebound
- Effect of Helicobacter pylori infection
- GASTRIC ACID HYPERSECRETION