Duodeno-jejunal junction: a histoanatomical study with the concept of the existence of an "anatomical" sphincter

[Duodenal motility in norm and in some diseases. Hypothesis]

AIM

to investigate the duodenal motility on the basis of radiological studies.

PATIENTS AND METHODS

We tested our hypothesis that sphincters of Kapandji and Ochsner are contracted in response to stimulation of duodenum by hydrochloric acid. These sphincters are not found in standard X-ray studies because barium does not contain hydrochloric acid when it coming from the stomach into the duodenum. The retrospective analysis of radiological studies of the upper digestive tract of 116 patients aged 55 to 92 years was done. The first group consisted of 83 patients in whom the study was conducted using conventional barium suspension. The second group consisted of 8 patients who received 200 ml of barium with the addition of 3 grams of vitamin C. The third group was comprised of 25 patients with primary duodenal diverticula. The fourth group included radiographs from 35 articles devoted to the superior mesenteric artery syndrome (SMAS). We measured the width of the duodenum and the length of the sphincters on these radiographs.

RESULTS AND CONCLUSION

We found an important role of the sphincters (bulbo-duodenal, Kapandji, Ochsner) in the duodenal physiology. On this basis, we proposed the hypothesis defining basic patterns of the duodenal motor function. Proposed hypothesis allows us to understand how the duodenum performs important functions and provides new avenues for understanding the pathogenesis of acquired diseases of the upper gastrointestinal tract. The different forms dyskinesia of these sphincters play an important role in the pathogenesis of the SMAS, primary duodenal diverticula and sphincter Oddi dyskinesia.