Relation of Coincident Anomalies of the Gastro-Intestinal Tract and Renal Ptosis to Digestive Disturbance

Abstract

Study of a group of patients with duodenal regurgitation revealed that congenital faults of the gastro-intestinal tract and of the urinary tract, and a short first metatarsal in the osseous system, were common. The digestive tract anomalies are seldom of clinical significance but act as signposts directing attention to the upper urinary tract as the reflex cause of the gastro-intestinal symptoms. Tixier and Clavel (1) showed by animal experimentation that traction on the renal pedicle produced definite reflex motor response in the gastro-intestinal tract. Smith and Orkin (2), inspired by that work, charted the reflex pathways over which such stimuli traveled and gave us the “reno-digestive reflex arc.” We thus have the explanation of why abnormal renal mobility and silent lesions of the upper urinary tract may give rise to symptoms in the alimentary tract. Abnormal renal mobility in women is found almost entirely in those with a short first metatarsal. Feet showing this characteristic are potentially weak and, when overused or fitted with short shoes, give rise to symptoms. Night cramps of the calf muscles are not uncommon, and the adductor longi muscles may be spastic. Study of additional cases since this paper was read shows that, if the pelvic muscles are examined, a spastic piriformis may usually be found, more often unilateral. This latter observation is important, as pressure on or massage of the piriformis may reproduce not only the low backache and supragluteal distress which occurs in so many of these cases but also, in about 20 per cent, will give rise to an indefinite distress or sometimes fairly sharp pain across the lower abdomen, between the navel and the symphysis pubis. Patients will state that this latter symptom is a distress or pain from which they frequently suffer and have attributed to gas. It is not the low right- or left-side pain from an overdistended kidney pelvis. One really puts his finger on the cause and exaggerates this distress if it is present or reproduces it if it is not. Gootnick (3) has discussed the mechanism of night cramps of the legs. Study seems to be indicated here to establish the “trigger mechanism” producing spasticity of the piriformis and sometimes, also, of the coccygeus and levator ani muscles, and to explain the association with abnormal renal mobility and short first metatarsals. A series of 179 patients (61 males and 118 females) was selected for this study because of the presence of duodenal regurgitation. The age grouping is shown in Table I. The significance of stasis and regurgitation has been a controversial subject. This is because the behavior patterns of the duodenum have been misunderstood. The close association of the pylorus, duodenum, and gallbladder must be recognized and they must be studied together. Delay in gastric emptying, duodenal regurgitation, gastrospasm and rapid gastric emptying require careful consideration.