Human Physiology, 14th edition (2016)

648 Chapter 18

Extrinsic afferents, together with the different peptide hor-

mones released from the intestine, alert the brain to the condi-

tions in the gastrointestinal tract. This information is important

in the CNS regulation of digestion and in both conscious and

unconscious perceptions of food intake and the state of the vis-

cera. The brain can sometimes overpower local, enteric ner-

vous system regulation during intense emotions of fear and

anger through stimulatory parasympathetic and inhibitory

sympathetic outflow from the CNS.

Paracrine Regulators of the Intestine

There is evidence that the enterochromaffin-like cells (ECL cells) of

the intestinal mucosa secrete serotonin, or 5-hydroxytryptamine,

in response to the stimuli of pressure and various chemicals. Sero-

tonin then stimulates intrinsic afferents, which conduct impulses

into the submucosal and myenteric plexuses and there activate

motor neurons. Motor neurons that terminate in the muscularis

can stimulate contractions; those that terminate in the intesti-

nal crypts can stimulate the secretion of salt and water into the

lumen. The ECL cells have also been shown to produce another

paracrine regulator, termed motilin, which stimulates contraction

in the duodenum and stomach antrum.

Guanylin is a paracrine regulator produced by the ileum and

colon. It derives its name from its ability to activate the enzyme

guanylate cyclase, and thus to cause the production of cyclic GMP

(cGMP) within the cytoplasm of intestinal epithelial cells. Act-

ing through cGMP as a second messenger, guanylin stimulates

the intestinal epithelial cells to secrete Cl^2 and water and inhibits

their absorption of Na^1. These actions increase the amount of salt

and water lost from the body in the feces. A related polypeptide,

called uroguanylin, has been found in the urine. This polypep-

tide is produced by the intestine and may function as a hormone

that stimulates the kidneys to excrete salt in the urine.

Intestinal Reflexes

There are several intestinal reflexes that are controlled both

locally, by means of the enteric nervous system and paracrine

regulators, and extrinsically through the actions of nerves and

hormones. These reflexes include:

1. the gastroileal reflex, in which increased gastric activ-

ity causes increased motility of the ileum and increased

movements of chyme through the ileocecal sphincter;

2. the ileogastric reflex, in which distension of the ileum

causes a decrease in gastric motility;

3. the intestino-intestinal reflexes, in which overdistension

of one intestinal segment causes relaxation throughout the

rest of the intestine.

Regulation of Pancreatic Juice

and Bile Secretion

The arrival of chyme into the duodenum stimulates the intes-

tinal phase of gastric regulation and, at the same time, stimu-

lates reflex secretion of pancreatic juice and bile. The entry of

insulin from the pancreatic islets. Because of incretin effects,
the experimental infusion of glucose into the jejunum is a more
powerful stimulator of insulin secretion than the infusion of
the same amount of glucose into the blood. GIP, as previously
described, acts in this manner and is thus an incretin. Later,
GLP-1 was shown to also act as an incretin and stimulate insu-
lin secretion in response to the ingestion of nutrients.

FITNESS APPLICATION

The neural and endocrine mechanisms that inhibit gastric

motility and secretion during the intestinal phase prevent the

further passage of chyme from the stomach to the duode-

num. This gives the duodenum time to process the load of

chyme it received previously. Because the small intestine is

most strongly stimulated to secrete the enterogastrone hor-

mones by the presence of fat in the chyme, a breakfast of

bacon and eggs takes longer to pass through the stomach—

and makes one feel “fuller” for a longer time—than does a

breakfast of oatmeal and fruit.

Regulation of Intestinal Function

Enteric Nervous System

The neurons and glial cells of the enteric nervous system (ENS)
are organized into ganglia that are interconnected by two plex-
uses. The outer myenteric (Auerbach’s) plexus is found along the
entire length of the GI tract; the inner submucosal (Meissner’s)
plexus is located only in the small and large intestine. The ENS
contains about 100 million neurons (roughly the same number
as in the spinal cord), and has a similar diversity of neurotrans-
mitters as the CNS. The ENS has interneurons as well as sensory
and autonomic motor neurons, and its glial cells resemble the
astrocytes of the brain.
Some sensory (afferent) neurons within the intestinal plex-
uses travel in the vagus nerves to deliver sensory information
to the CNS. These are called extrinsic afferents, and they are
involved in regulation by the autonomic nervous system. Other
sensory neurons—called intrinsic afferents —have their cell bod-
ies in the myenteric or submucosal plexuses and synapse with
the interneurons of the enteric nervous system. An estimated 100
million intrinsic afferents greatly outnumber the 50,000 extrinsic
afferents in the intestine, emphasizing the importance of local
regulation of intestinal function.
Peristalsis, for example, is regulated by the enteric nervous
system. A bolus of chyme stimulates intrinsic afferents (with cell
bodies in the myenteric plexus) that activate enteric interneurons,
which in turn stimulate motor neurons. These motor neurons
innervate both smooth muscle cells and interstitial cells of Cajal,
where they release excitatory and inhibitory neuro transmitters.
Smooth muscle contraction is stimulated by the neurotransmit-
ters ACh and substance P above the bolus, and smooth muscle
relaxation is promoted by nitric oxide, vasoactive intestinal pep-
tide (VIP), and ATP below the bolus ( fig. 18.31 ).