Antiperistalsis

Antiperistalsis (from the Greek anti- against and peristalsis - worm-like movement), a 'worm-like' movement going in the reverse direction, dependent on the contraction of the circular smooth muscles of the stomach and intestines. A. is observed, as one of the moments of physiological digestion, in the region of the stomach outlet, in the cecum, in the ascending colon, and in the first third of the transverse colon. Thanks to A., insufficiently yet thickened intestinal content is pushed back to the beginning of the large intestine for further processing. After certain intervals of time, when the intestinal content becomes sufficiently thick, A. is replaced by peristaltic waves, which drive the content into the descending colon. In other parts of the intestine, A. is usually not observed under normal conditions. Even if a piece of the small intestine is cut out in a dog, turned 180°, and sewn back into the intestine, antiperistaltic waves will apparently go in this piece of intestine, i.e., the piece retains its normal peristalsis. Only under pathological conditions, when normal peristalsis encounters insurmountable resistance, can antiperistalsis occur, for example, in the esophagus with cardiospasm or in the stomach with pyloric or duodenal stenosis, etc. - Antiperistalsis of the stomach. In the presence of any obstacle in the stomach outlet or with a deep constriction in its middle part, A., along with a sharp intensification of peristalsis, can be so deep and strong that it is sometimes visible to the naked eye. A. is intensified with filling of the stomach and can be caused by short taps of the fingers in the epigastric region, by spraying it with ether, or by slapping with a wet towel. A., spreading throughout the stomach, is one of the cardinal symptoms of narrowing in the stomach. This symptom can also be found in 'nervous peristalsis of the stomach' - a rare disease described by Kussmaul. Peristalsis and A. in this disease are accompanied by rumbling in the abdomen, appear at different times, and intensify with emotional excitement; treatment of the disease is etiological. - A. of the esophagus, according to all researchers, does not even occur with vomiting. The throwing back into the mouth of swallowed material (regurgitation) does not depend on antiperistalsis: the swallowing movement causes energetic contraction of the esophageal musculature (peristalsis) and drives the contents downward in the normal direction; when it encounters an obstacle on its path, it is thrown back into the mouth. The food thrown back is not digested and is mixed with mucus. These regurgitations, more sharply expressed with esophageal stenoses, are also observed with any violation of the normal function of its musculature. - A. of the intestines in a normal state is observed in the cecum, ascending colon, and first third of the transverse colon - for more thorough mixing of the contents (Cannon, Boehm, Bloch). A. in the intestines depends, according to Fleiner (Fleuner), on the appearance of a stronger tone in the distal part - then the peristaltic wave goes retrogradely. In cases of intestinal stenosis, one can observe not only an intensification of the peristaltic wave (with hypertrophy of the intestinal wall), but also A. of Nothnagel - jerky contractions in the reverse direction. Sharp A. can lead to vomiting of intestinal contents (in hysterical subjects); fecal vomiting in ileus more often occurs not as a result of A., but because the stagnant fecal masses in the paralyzed intestine are driven into the stomach by the abdominal press. In some patients, when strong solutions of salt or various small particles (lycopodium, dyes) or vegetable oil are introduced into the rectum - these substances appear in the stomach (reverse border movement). The latter speaks for antiperistalsis of the intestines, provided these patients do not have a gastroenteric fistula. Lit.: Nothnagel K., Erkrankungen des Darms und des Peritoneums, Wien, 1898; Cannon W. B., Amer. journ. of physiol., v. II; Bloch W., Med. Klin., 1911, № 6; Schraidt A., Klinik der Darmkrankheiten, herausg. v. Noorden, München, 1921; Bethe A., Bergmann G. usw., Handb. d. norm. u. path. Physiol., B. III, p. 367, 398, 455, 1927.