Module 3: The gastrointestinal system

Digestion begins with food being ingested into the mouth, being chewed by the
teeth, and production of saliva from the salivary glands. An average adult secretes
around 1 to 2 liters of saliva each day, Saliva is composed of water, electrolytes,
mucus, enzymes and antibacterial substances. Its primary function is to lubricate
food and begin the chemical digestive process. A key salivary enzyme is amylase,
important in commencing the digestions of starch. After food is ingested,
swallowing is a reflex that involves sensory receptors in the back of the throat
detecting the food bolus with a resultant contraction of the pharynx. At the same
time relaxation of the upper oesophageal sphincter occurs allowing food to move
into the oesophagus. The food bolus in the oesophagus is then propelled by
peristalsis to the stomach.

Learning objectives

By the end of this unit, you should be able to:

Describe the various components of saliva.

Describe the process of swallowing.

Identify the location and the control of the sphincters involved with swallowing.

Digestion

Digestion in the mouth

Ingestion and digestion (mechanical and chemical) breakdown begins in the mouth.
The mouth and oropharynx breakdown down food by grinding/chewing and lubricate
it with saliva. Next the food is pushed into the oesophagus as the individual
swallows.

Saliva is secreted by the salivary glands. It is a watery secretion containing mucus,

digestive enzymes, salts, and antibacterial agents.

There are four enzymes in saliva:

amylase - hydrolysis of starch (digestion)

lipase - hydrolysis of lipids (digestion)

lysozymes - hydrolysis of bacterial cell walls (anti-microbial)

lactoperoxidase - generates bactericidal oxidised compounds (anti-microbial)

So, the digestion of carbohydrates and lipids commences in the mouth. Mucus coats
the food, minimising epithelial cell damage along the GIT. Saliva also acts as a
antimicrobial wash.

Both the parasympathetic and sympathetic divisions of the autonomic nervous

system innervate the salivary glands. Either food in the mouth (taste), sight, smell or
even just the thought of eating food stimulates parasympathetic nerves to release
acetylcholine leading to increased salivary secretion - watery, less alkaline saliva.
Sympathetic nervous system release of noradrenaline causes a drier mouth, a small
increase in mucus rich salivary secretion.

Swallowing

The process of swallowing is known as deglutition. It is a highly coordinated

physiological act involving 22 different muscle groups that are innervated by our
cranial nerves.

Deglutition takes over the course of 3 phases:

1st phase - The oral/buccal phase: the tongue moves the bolus from the oral cavity
into the oropharynx.

2nd phase - The pharyngeal phase: the bolus is moved from the oropharynx into
the oesophagus.

3rd phase - The oesophageal phase: the bolus is moved from the oesophagus into
the stomach.

These phases, and some of the muscle groups involved, can be seen in this figure
below.

Image source: Deglutition. Access for free at

https://openstax.org/books/anatomy-and-physiology/pages/23-3-the-mouth-pharynx-and-
esophagus

The oral phase

The oral phase is under voluntary control, where you contract your tongue and push
against the soft palate. Then back towards the oropharynx, forcing the food into a
bolus from the oral cavity into the oropharynx. While this occurs, the upper
esophageal sphincter is closed and food cannot pass through into the oesophagus
until it is opened during the pharyngeal phase.

The pharyngeal phase

As the bolus reaches the oropharynx (see figure below), pressure is exerted on the
posterior oropharynx sensory receptors. These receptors, via vagal afferent
nerves, relay information to the medullary region of the brainstem causing an
involuntary phase. The tongue is pushed back blocking the oral cavity and
preventing food backflow. The uvula and soft palate are elevated, blocking off the
nasopharynx, and access to the nasal cavity. The larynx is elevated, widening the
pharynx, and closing the epiglottis over the trachea - preventing food entering the
respiratory system. Finally, the upper oesophageal sphincter (UES) relaxes, allowing
food to move into the oesophagus. The pharynx will then contract, moving food into
the oesophagus.

Image source: Pharynx. Access for free at https://openstax.org/books/anatomy-and-

physiology/pages/23-3-the-mouth-pharynx-and-esophagus

Note a relationship between swallowing and respiration. The UES is

normally closed during inspiration, diverting atmospheric air to the glottis,
rather than the oesophagus. During swallowing, the glottis is closed and
there is an inhibition in respiration (via sensory input to the respiratory drive
centre in the medulla). So with relaxation of the UES and swallowing, food
will not enter the lungs.

Some events in the pharyngeal phase can be seen on the short video below.

Image source: Real-time MRI-Swallowing. By Biomedizinische NMR Forschungs GmbH, CC BY-SA

3.0, via Wikimedia Commons.

The oesophageal phase

Once bolus enters the oesophagus, peristalsis propels the bolus down the length of
the oesophagus and into the stomach. Remember, these are involuntary waves of
smooth muscle contraction and relaxation (see figure below). The gastro-
oesophageal or lower oesophageal sphincter (LES), at the junction of the
oesophagus and stomach relaxes to allow the movement of the food bolus into the
stomach, and afterwards closes/contracts to prevent regurgitation. The LES has a
resting tone, as it is comprised solely of smooth muscle. Relaxation of the LES
occurs due to either vagal nerve activity or by intrinsic myogenic properties of the
smooth muscle. As a general rule regarding GIT sphincters, stimuli proximal to the
sphincter cause relaxation, whilst those distal to the sphincter cause contraction
(note such in the figure below for peristalsis). For the LES, a reduced resting tone will
result in gastro-oesophageal reflux disease (GORD), commonly referred to as gastric
reflux.

The muscles of the pharynx and soft palate that were contracted during the
pharyngeal phase now relax, open for air conduction and for additional food.

Image source: Peristalsis. Access for free at https://med.libretexts.org/Bookshelves/Nutrition/