Mechanism of Interdigestive Migrating Motor Complex

Takahashi, Toshio

doi:10.5056/jnm.2012.18.3.246

Cited by 51 publications

(36 citation statements)

References 85 publications

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“…This cyclical phenomenon is called the migrating motor complex (MMC). The process of MMC is divided into four consecutive phases: basal (Phase I), pre-burst (Phase II), burst (Phase III) and Phase IV intervals (Figure 1; Vantrappen et al, 1979;Chawla et al, 2003;Takahashi, 2012). Plasma motilin level (stored in the duodenum) is highly associated with the appearance of gastric phase III of MMC (Sarna, 1985;Schemann & Ehrlein, 1986;Wilding et al 2001;Romanski, 2009).…”

Section: Gastrointestinal Motility and Gastric Emptying Of Dosage Formsmentioning

confidence: 95%

Decades of research in drug targeting to the upper gastrointestinal tract using gastroretention technologies: where do we stand?

Awasthi

Kulkarni

2014

Drug Delivery

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A major constraint in oral controlled release drug delivery is that not all the drug candidates are absorbed uniformly throughout the gastrointestinal tract (GIT). Drugs having "absorption window" are absorbed in a particular portion of GIT only or are absorbed to a different extent in various segments of the GIT. Thus, only the drug released in the region preceding and in close vicinity to the absorption window is available for absorption. The drug must be released from the dosage form in solution form; otherwise, it is generally not absorbed. Hence, much research has been dedicated to the development of gastroretentive drug delivery systems that may optimize the bioavailability and subsequent therapeutic efficacy of such drugs, as these systems have unique properties to bypass the gastric emptying process. These systems show excellent in vitro results but fail to give desirable in vivo performance. During the last 2-3 decades, researchers from the academia and industries are giving considerable importance in this field. Unfortunately, till date, few so-called gastroretentive dosage forms have been brought to the market in spite of numerous academic publications. The manuscript considers strategies that are commonly used in the development of gastroretentive drug delivery systems with a special attention on various parameters, which needs to be monitored during formulation development.

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Section: Gastrointestinal Motility and Gastric Emptying Of Dosage Formsmentioning

confidence: 95%

Decades of research in drug targeting to the upper gastrointestinal tract using gastroretention technologies: where do we stand?

Awasthi

Kulkarni

2014

Drug Delivery

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“…Released 5-HT initiates duodenal phase II via 5-HT 4 receptors of IPAN. Thus, the initiation of duodenal phase II is not due to the increase of plasma motilin release (65). …”

Section: Mechanism Mediating Gastric MMC and Intestinal Mmcmentioning

confidence: 99%

“…This positive circuit (pressure increase and 5-HT release) enhances the amplitude of duodenal phase II, leading to duodenal phase III. Finally, maximally increased duodenal pressure stimulates motilin release, resulting in gastric phase III (65). Briefly, initial stimulator of MMC is released 5-HT in response to intraluminal pressure increase during duodenal phase II.…”

Section: Mechanism Mediating Gastric MMC and Intestinal Mmcmentioning

confidence: 99%

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Interdigestive migrating motor complex -its mechanism and clinical importance

Takahashi

2013

J Smooth Muscle Res

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Migrating motor complex (MMC) is well characterized by the appearance of gastrointestinal (GI) contractions in the interdigestive state. The physiological importance of gastric MMC is a mechanical and chemical cleansing of the empty stomach in preparation for the next meal. MMC cycle is mediated via the interaction between motilin and 5-hydroxytryptamine (5-HT) by the positive feedback mechanism in conscious dogs. Luminal administration of 5-HT initiates duodenal phase II and phase III with a concomitant increase of plasma motilin release. Duodenal 5-HT concentration is increased during gastric phase II and phase III. Intravenous infusion of motilin increases luminal 5-HT content and induces phase III. 5-HT4 antagonists significantly inhibit both of gastric and intestinal phase III, while 5-HT3 antagonists inhibit only gastric phase III. These suggest that gastric MMC is regulated via vagus, 5-HT3/4 receptors and motilin, while intestinal MMC is regulated via intrinsic primary afferent neurons (IPAN) and 5-HT4 receptors. We propose the possibility that maximally released motilin by a positive feedback depletes 5-HT granules in the duodenal EC cells, resulting in no more contractions. Stress is highly associated with the pathogenesis of functional dyspepsia (FD). Acoustic stress attenuates gastric phase III without affecting intestinal phase III in conscious dogs, via reduced vagal activity. Subset of FD patients shows reduced vagal activity and impaired gastric phase III. The impaired gastric MMC may aggravate dyspeptic symptoms following a food ingestion. Maintaining MMC cycle in the interdigestive state is an important factor to prevent the postprandial dyspeptic symptoms.

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“…The overall periodicity of the MMC in humans varies individually but is in the range of 80–120 min, with the active phase III lasting 15–25 min [95]. With meals the MMC is broken, and the work of the stomach starts to resemble a semi-active phase of the MMC until it empties completely [96]. After gastric emptying, the fasting MMC pattern is restored [97].…”

Section: Types Of Gastric Electrical Stimulation For the Treatmentmentioning

confidence: 99%

Gastric Electrical Stimulation for the Treatment of Obesity: From Entrainment to Bezoars—A Functional Review

Mintchev

2013

ISRN Gastroenterology

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Growing worldwide obesity epidemic has prompted the development of two main treatment streams: (a) conservative approaches and (b) invasive techniques. However, only invasive surgical methods have delivered significant and sustainable benefits. Therefore, contemporary research exploration has focused on the development of minimally invasive gastric manipulation methods featuring a safe but reliable and long-term sustainable weight loss effect similar to the one delivered by bariatric surgeries. This antiobesity approach is based on placing external devices in the stomach ranging from electrodes for gastric electrical stimulation to temporary intraluminal bezoars for gastric volume displacement for a predetermined amount of time. The present paper examines the evolution of these techniques from invasively implantable units to completely noninvasive patient-controllable implements, from a functional, rather than from the traditional, parametric point of view. Comparative discussion over the available pilot and clinical studies related to gastric electrical stimulation outlines the promises and the fallacies of this concept as a reliable alternative anti-obesity strategy.

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Mechanism of Interdigestive Migrating Motor Complex

Cited by 51 publications

References 85 publications

Decades of research in drug targeting to the upper gastrointestinal tract using gastroretention technologies: where do we stand?

Decades of research in drug targeting to the upper gastrointestinal tract using gastroretention technologies: where do we stand?

Interdigestive migrating motor complex -its mechanism and clinical importance

Gastric Electrical Stimulation for the Treatment of Obesity: From Entrainment to Bezoars—A Functional Review

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