Last edited: 8/31/2021

1. GASTRIC SECRETION: THE INTESTINAL PHASE

Gastric Secretion: The Intestinal Phase Medical Editor: Dr. Sofia Suhada M. Uzir

OUTLINE II) INTESTINAL PHASE

I) PHASES OF GASTRIC SECRETION

II) INTESTINAL PHASE
III) PROTECTIVE MECHANISM OF THE STOMACH
IV) REVIEW QUESTIONS
V) REFERENCES

I) PHASES OF GASTRIC SECRETION

Cephalic phase
o 1/3 of the gastric secretion
o Before the food enters the stomach Figure 1. The overview of intestinal phase of gastric secretion
[Austin Community College]
Gastric phase
o 2/3 of the total gastric secretion (A) STIMULATORY FACTORS
o When the food in in the stomach Increase the acid secretion by:
o Affected by stretch/distension and concentration of (1) Partially digested proteins
peptides, particularly partially digested proteins
Acts through the release of intestinal gastrin (G34)
Intestinal phase When the chyme reaches the duodenum
o Doesn’t account a significant amount of gastric juices

Remember:
Parietal cells not only secrete hydrochloric acid, it also
secretes intrinsic factors which is important for absorbing
vitamin B12

(i) The parietal cell

Gastrin binds to receptors on the parietal cell

(A) THE BASIC MOTILITY OF THE STOMACH

When the stomach contracts it produce generally 3 very Recap:
strong peristaltic contractions starting at the cardia → Different parts of the stomach:
o Cardia
moves down to the fundus → antrum → and reaches
o Fundus
the pylorus, where the waves are the strongest →
o Corpus
muscularis externa contracts o Antrum
o Pushes 25% of chyme, which are bolus that have  G-cells secrete gastrin peptide (G17)
been digested with gastric juice in the stomach, back  They have the same function but different in amino
to the corpus (retropulsion) → to continue mixing the acid composition than intestinal gastrin, G34 which
chyme with hydrochloric acid and pepsin is secreted by duodenal mucosa
 Some gets chemically digested o Pylorus with the sphincter
 Others are digested mechanically later on
o Pushes approximately 3 ml of chyme out into the
duodenum
 This amount lets the duodenum be ready and
makes modifications when needed
 This also prevents damage to the duodenal lining
due to the high proton concentration of the
stomach chyme
Contents of the chyme
o Glucose
o Protons
o Partially digested proteins (peptones)
o Fatty acid Figure 2. Parts of the stomach [Austin Community College]

GaSTRIC SECRETION: The Intestinal Phase GASTROINTESTINAL PHYSIOLOGY: Note #1. 1 of 5

 Functions of secretin:

(i) In the stomach

Inhibits the gastric acid secretion
Mechanism:
o Secretin travels through the blood vessels reaching
the antral G-cells of the stomach → bind to the
receptors on the G-cells → inhibit the G-cells → the
release of gastrin will be inhibited → hydrochloric acid
secretion will be inhibited

(ii) In the liver

Stimulates liver to make bile
Mechanism:
o Secretin travels to the liver

Figure 3. The stimulation and inhibition of gastric parietal cells

with the H,K-ATPase [Semantic Scholar]

(ii) The chief cell

Gastrin also has receptors on the chief cell → binds to
this receptor → stimulate the vesicles in the chief cell to
fuse with the cell membrane → contents of the vesicles,
which is pepsinogen, will be released into the lumen of
the stomach
o Pepsinogen can be converted into pepsin at an
optimal pH of 1.8-3.5 (concentrated protons)
o Pepsin is a protein digesting enzyme

Note: Note:
Pepsinogen (inactive form) → pepsin (active form) can Bile contents
interchange depending on the pH levels o Bile acids and salts
o Pepsinogen to pepsin = 1.8-3.5 o Phospholipids
o Pepsin to pepsinogen = greater than 3.5 o Cholesterol
o A pH of greater than 7.2 creates an irreversible o Pigments
inactivation of pepsinogen o Water
The more acidic the environment → the higher the o Electrolyte chemicals
conversion rate of pepsinogen to pepsin → the more the
proteins will be digested (iii) In the pancreas
But a very acidic environment can inhibit the secretion of Secretin responds to acidic chyme
hydrochloric acid → inhibit the conversion of pepsinogen to
Stimulates ductal epithelial cells to make bicarbonate
pepsin
Mechanism:
o Secretin binds to the receptor on acinar ductal
(2) Entero-oxyntin epithelial cells
Can respond to the same type of stimulus
o Increase in concentration of peptones
Stimulate different types of endocrine cells (not exactly
known which type) (2) Cholecystokinin (CCK) hormone (Figure 1)
Released by enteroendocrine I-cells which is stimulated
by high concentration of:
o Fatty acids (fatty chyme)
o Partially digested proteins (peptones)
o Oligosaccharides (hyperosmolar chyme)
(3) Secretin Functions of CCK:
Not very significant (i) In the stomach
Stimulate the chief cells to make pepsinogen Inhibits the release of hydrochloric acid
(B) INHIBITORY FACTORS This is important because the duodenum is filled with
partially digested substances → so slowing the acid
Decrease the acid secretion by: secretion slows down the emptying of the stomach
(1) Secretin The high proton concentration in the chyme can also
damage the duodenal lining causing ulcers
Secreted by S-cells Mechanism:
S-cells release secretin in response to: o CCK goes into the blood to reach the parietal cells of
o Increase concentration of protons the stomach
o Increase concentration of fats (fatty acid)

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 (ii) In the liver
Binding of CCK to the receptor on the liver accentuates
the action of secretin
This increases bile synthesis → which increase the
concentration of bile acids → bile acid reacts with the
fatty acids and emulsify it → this helps in digestion and
absorption of fat (Figure 4)

(iii) In the gall bladder

Causes gall bladder contractions and relaxes the
sphincter of Oddi
Mechanism:
o CCK binds to receptor on the gall bladder → gall
bladder contracts → squeeze out any concentrated
bile → CCK binds itself to the receptor on the
sphincter of Oddi → and stimulates the sphincter and
relaxes it→ the bile will be released into the duodenal
mucosa
Remember:
Gall bladder helps in concentrating bile by getting rid of a lot
of water and electrolytes
Figure 5. CCK helps in releasing of the digestive enzymes
[Doctor Library]
(3) Peptide YY and neurotensin chemicals
Released by different types of endocrine cells
The endocrine cells are activated by stretch
Mechanism:
o A lot of chyme in the intestine → distension of the wall
→ activate different endocrine cells → release
peptide YY and neurotensin → move through the
blood → act on receptors present on the parietal cells
→ inhibit the hydrogen potassium ATPase via
signaling pathway → less hydrochloric acid
production
o This prevents the excessive release of acidic chyme
into the duodenum
(4) Gastric inhibitory peptide (GIP) chemical
Also known as glucose-dependent insulinotropic peptide
Released by enteroendocrine K-cells which responds to
high concentrations of oligosaccharides/polysaccharides
and fats
Functions of GIP:

(i) In the stomach

Inhibit gastric secretion (Figure 4)
Mechanism:
o Travels through the blood to reach the parietal cells
Figure 4. CCK which was stimulated by the fat contents helps → bind to the GIP receptors on the parietal cells →
in the release of bile [Doctor Library] triggers intracellular inhibitory signals → inhibits the
parietal cells from releasing hydrochloric acids
(iv) In the pancreas
Inhibit GI emptying
CCK stimulate the acinar cells to release digestive o Inhibiting the chyme from entering the duodenum
enzymes (Figure 4)
Acinar cells in the acini are concentrated with granules
which are rich in different types of digestive enzymes:
o Pancreatic proteases
• Trypsin
• Chymotrypsin
• Carboxy peptidase
 Helps in digestion and absorption of proteins
• Peptones
o Pancreatic amylase
 Helps in digestion of
oligosaccharides/polysaccharides
o Pancreatic lipase
 Helps in digestion of fatty acids
o Pancreatic nuclease
Mechanism:
o CCK bind to the receptors on the acinar cells and
stimulate fusion of vesicles with cell membrane
 Release substances by exocytosis
 The enzymes are precursors, which means they
are inactive and needs to undergo certain
chemical reactions in the duodenum to be
activated
• This is important because the active form
can react with the epithelial cells of
pancreas, digesting it as what may happen Figure 6. Regulation of gastric acid secretion [Doctor Library]
in pancreatitis

GaSTRIC SECRETION: The Intestinal Phase GASTROINTESTINAL PHYSIOLOGY: Note #1. 3 of 5

 (ii) In the pancreas III) PROTECTIVE MECHANISM OF THE STOMACH
Stimulate insulin release The proton concentration in the stomach is 100,000
Mechanism: times more concentrated than in the blood
o Islets of Langerhans contains: The mucosal barrier protects the stomach from being
 Alpha cells digested by this very acidic environment
 Delta cells The barrier is consisted of:
 Polypeptide cells
 F cells (i) Mucus gel layer (Figure 7)
 Beta cells o Located at the top, which made up of:
• Contain receptors which are sensitive to  Water (95%)
glucose  Electrolytes
o Insulinotropic peptide/gastric inhibitory • Sodium
peptide
• Potassium
• Stimulate the release of insulin  Phospholipids
o Insulin is primarily responsible to decrease  Mucin proteins
blood glucose levels • It is the most important
o Primarily released during feeding/fed state
• Increase the viscosity and forms the thick
o This helps in increase in glucose and
mucosal barrier
amino acids uptake → increase
• Prevents the proton from damaging the
glycogenesis, lipogenesis and protein
epithelial layer
synthesis
(5) Acetylcholine (ii) Bicarbonate
o High concentration of bicarbonate at the bottom
Released by the vagus nerve (cranial nerve X) from the
central nervous system  Basic substance
Functions of acetylcholine:  Right above the mucosal cells
• If the pepsin secretion starts rising and tries to
(i) In the pancreas move through the gel layer, the bicarbonate
will inhibit the pepsin and turns it into the
Stimulate insulin release
pepsinogen
Mechanism:
• If the protons by chance penetrate through the
o Acetylcholine released → bind to the muscarinic
gel layer → it will combine with bicarbonate →
receptors of the pancreatic beta cells → stimulate the
forming carbonic acid → carbonic acid breaks
beta cells to release insulin
down into carbon dioxide (the burping gas)
Relaxes the sphincter of Oddi by binding to the receptors and water
on the sphincter

(ii) In the gallbladder

Bind to the receptors in the gallbladder → help in
gallbladder contractions (Figure 4)
(6) Chemoreceptors
Activated by the high concentration of protons
Remember:
o Vagus nerve have fibers that reach the parietal cells
→ parietal cells are very sensitive to acetylcholine
(strongest stimulus) → acetylcholine that act on the
parietal cells stimulate the hydrochloric acid
secretion

(i) Inhibition of parasympathetic outflow

High concentration of protons may destroy the duodenal
lining → the chemoreceptors detect the high
concentration of protons → inhibit the vagus nerve →
decrease the hydrochloric acid secretion Figure 7. Outline of gastric mucin [Paola Tonino]

(ii) Stimulation of sympathetic outflow

Chemoreceptor fibers stimulate the paravertebral
ganglion (celiac ganglion to the stomach)

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 IV) REVIEW QUESTIONS
1) About the GIT hormones affecting gastric function:
a) CCK and secretin increase both gastric secretion
and motility
b) gastrin secretion is stimulated by the digestive
products of fat
c) gastrin inhibits gastric secretion and delay gastric
emptying
d) GIP and VIP inhibit gastric secretion
e) Somatostatin is a powerful Stimulator to both gastric
Secretion and motility
2) The rate of gastric emptying is delayed by all of the
following except
a) The enterogastric reflex
b) The gastrin hormone
c) A moderate stomach distension
d) None of the above
3) Acidification of the duodenum will:
a) Decrease pancreatic secretion of bicarbonate
b) Increase secretion of gastric acid
c) Decrease gastric emptying
d) Increase contraction of the gall bladder
4) Mucous presents on the surface of the mucosa of
the stomach, small and large intestine is:
a) Resistant to enzymes secreted into the lumen of the
gastrointestinal tract
b) Alkaline, and thus a poor buffer for alkaline foods
c) A non-amphoteric protein
d) Easily removed from the surface of the stomach by
the gastric secretions during the gastric phase of
digestion
5) The enterogastric reflex can be elicited by which of
the following?
a) Distension of the duodenum
b) Acid chime in the duodenum
c) Hyperosmotic chime in the duodenum
d) All of the above
6) The secretion of gastrin by the pyloric antrum
ceases:
a) When the stomach is distended by a full meal
b) When the gastric mucosa contents have a pH of
about 2.0
c) If histamine is injected
d) If the vagi are stimulated
7) Which of the following substances is released from
the duodenal mucosa in response to acidic gastric
juice?
a) Histamine
b) Secretin
c) Norepinephrine
d) Acetylcholine
GaSTRIC SECRETION: The Intestinal Phase
8) The chyme entering the small intestine causes a
release of secretin which results in:
a) Stimulation of pancreatic fluids which there are no
enzymes
b) A pancreatic fluid that aids in protection against the
development of duodenal ulcers
c) A pancreatic secretion whose pH is just right for
action of the pancreatic enzymes that are eventually
released
d) Pancreatic fluid secretion of a large volume
containing low chloride but high bicarbonate
concentration
e) All are correct
9) Which of the following is the major factor that
protects the duodenal mucosa from the damage by
gastric acid?
a) Pancreatic bicarbonate secretions
b) The endogenous mucosal barrier of the duodenum
c) Duodenal bicarbonate secretion
d) Hepatic bicarbonate secretion
e) Bicarbonate contained in bile
10) Which of the following substances is released from
the duodenal mucosa in response to acidic gastric
juice?:
a) CCK
b) Substance P
c) Secretin
d) GIP
CHECK YOUR ANSWERS
V) REFERENCES
● MCQ digestion [quiz]
http://www1.mans.edu.eg/facmed/dept/physiology/pdf/digestion.pdf
● Paola Tonino; Gastritis and Gastric Cancer - New Insights in
Gastroprotection, Diagnosis and Treatments. Mucin Overview
[dogotal image] https://www.intechopen.com/chapters/19866
● Austin Community College; Digestive System. Parts of the
stomach and the overview of the digestive system [digital images]
https://www.austincc.edu/apreview/PhysText/Digestive.html
● Doctor Library; Physiology - An Illustrated Review;
Gastrointestinal Secretion. Regulation of gastric acid scretion, bile
release and CCK functions [digital images]
https://doctorlib.info/physiology/illustrated/26.html
● J. G. Forte, Lixin Zhu. Semantic Scholar; Apical recycling of the
gastric parietal cell H,K-ATPase. [digital image]
https://www.semanticscholar.org/paper/Apical-recycling-of-the-
gastric-parietal-cell-Forte-
Zhu/2674690ca508533484c1b87e0c2757e37f0ce862
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