Slow wave conduction patterns in the stomach: from Waller's foundations to current challenges

Abstract

This review provides an overview of our understanding of motility and slow wave propagation in the stomach. It begins by reviewing seminal studies conducted by Walter Cannon and Augustus Waller on in vivo motility and slow wave patterns. Then our current understanding of slow wave patterns in common laboratory animals and humans is presented. The implications of slow wave arrhythmic patterns that have been recorded in animals and patients suffering from gastroparesis are discussed. Finally, current challenges in experimental methods and techniques, slow wave modulation and the use of mathematical models are discussed.

Keywords: arrhythmia; gastroparesis; interstitial cells of Cajal; slow wave patterns; smooth muscle.

Figure 1

Sketches by Walter Cannon (1871–1945) illustrating the changes in the shape of the stomach during the digestion of a meal. Each panel shows the outline of the stomach of a cat determined by x-ray at 1 hour intervals. Adapted from (Cannon 1911).

Figure 2

Santigo Ramon y Cajal (1852–1934), a pioneering neuroscientist, in his laboratory.

Figure 3

Schematic of the normal human conduction system. Rapid and high amplitude slow wave activity originates at the pacemaker, rapidly forming bands of activity that propagate distally. The corpus has slow and low amplitude activity, while towards the distal antrum, rapid, high-amplitude activity occurs. The pylorus and fundus are absent of slow wave activity. Adapted from (Cheng et al. 2013).