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Meaningful or redundant complexity – mechanisms behind cyclic changes in gastroduodenal pH in the fasting state

The antroduodenal region is probably the site of the most common chronic infection of mankind, helicobacter‐induced antral gastritis. After meals, the remaining gastric contents are evacuated by an interdigestive motor programme, the so‐called migrating motor complex (MMC). The most characteristic feature of the MMC is phase III, a series of contractions at slow wave frequency (3 min−1 in the stomach, approx. 12 min−1 in the duodenum). Phase III is associated with complex changes in antroduodenal pH, the most prominent feature being a rapid alkalinization of the antral lumen immediately after the end of antral phase III. Before and during antral phase III (late phase II), gastric acid secretion increases and reflux of bile‐containing fluid from the duodenum frequently occurs. At the start of duodenal phase III, the pacemaker driving the motor waves is located proximally in the contracting segment, and the motor waves are uniformly antegrade. After passing the papilla, the pacemaker which is now in the middle of the contracting segment stops its migration and waves passing the papilla hence become retrograde. Bile is diverted into the gall bladder. Duodenal phase III activates electrogenic chloride and bicarbonate secretion and release of secretory IgA. During the second half of phase III, there is accordingly reflux of bile‐free fluid, bicarbonate and secretory IgA containing fluid from the duodenum into the stomach. Possible physiological and pathophysiological implications of this complex system, in particular the role of the gastric mucus layer in antral Helicobacter infection, will be discussed.