Nutrient Regulation of Motility and Transit

Traditional experimental techniques in which simple nutrient substrates were introduced by tube into the 'starved' human duodenum found that, under these conditions, most nutrients were absorbed immediately within the proximal tenth of the small intestine. Real food offers a more complex problem for the small intestine since the processes of digestion have only been initiated within the lumen of the stomach. It is apparent that the major part of digestion takes place along a significant fraction of the whole small intestine, with the processes of absorption occurring, as a consequence, along the majority of segments. Certainly, enterocyte functional capacity on ideal villi is comparable to that on the jejunum.

These observations have been supported by findings that meals of a high nutrient density are more slowly emptied from the stomach and pass along the small intestine at a reduced rate. Evidence exists for a regulatory mechanism situated within the mucosa of the terminal ileum capable of sensing nutrient presence such as lipid and providing feedback restraint on moti-lity patterns in the stomach, duodenum, and jejunum to slow the passage of meals in proportion to their nutrient density. This mechanism has been called the 'ileal brake' and, taken with the hormonal control of gastric emptying, explains the almost complete absorption of meals of the highest nutrient density.

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