Neural-Humoral-Paracrine Control of the GI Tract

Secretory Products
Product
Intrinsic Factor

Source
Parietal cells

Action
Necessary for B12
absorption in terminal
ileum

Gastric Acid

Parietal Cells

Provide acidic
environment

Pepsin

Chief Cells

Digestion of proteins

HCO3-

Mucosal cells in
stomach and
duodenum

Neutralize acid in
stomach; prevents
autodigestion

Regulation

Notes
Autoimmune
destruction of parietal
cells chronic
gastritis and
pernicious anemia
by histamine, ACh,
Gastrinoma: gastringastrin
secreting tumor that
by somatostatin,GIP, causes continuous
PG, secretin
high levels of acid
secretion and ulcers.
by vagal stimulation, Inactive pepsinogen
local acid
pepsin by H+
by secretin
HCO3- is trapped in
mucus that covers the
gastric epithelium

Hormone/
Site of
Paracrine/
Production
Neurotransmitter
Acetylcholine
Parasympathetic nerves
Enteric nerves

Stimulus for Production

Neural reflexes

Bombesin
(Gastrinreleasing
peptide, GRP)
Cholecystokinin
(CCK)

Vagal & enteric

neurons in
stomach mucosa

Neural reflexes
Dietary protein, amino
acids

I cells in
duodenal, jejunal
submucosa

Fatty chyme
Partially digested
proteins, amino acids

Gastric
Inhibitory
Polypeptide
(GIP)

K cells in
duodenal, jejunal
mucosa

Fatty chyme
Glucose containing
chyme

Target Organ and Action

Salivary glands: stimulate secretion
Esophagus: stimulates motility
Stomach: stimulates motility and secretions of acid,
pepsinogen
Small intestine: stimulate motility and secretion
Gallbladder: stimulates contraction
Pancreas: stimulates enzyme secretion
Stomach: stimulates release of gastrin
Pancreas: stimulates secretion
Stomach: decreases motility and delays emptying;
inhibits acid secretion
Small intestine: stimulates motility
Gallbladder: stimulates contraction to expel stored
bile; relaxes sphincter of Oddi (Cholelythiasis = CCK)
Pancreas: stimulates enzyme secretion; potentiate
action of secretin
Mediates satiety
Stomach: inhibits acid (H+) secretion
Small intestine: inhibit motility
Pancreas: stimulates insulin release

Gastrin

G-cells in
gastric antrum of
stomach
(enteroendocrine
cells) in
submucosa

Protein, amino acids, Ca+

+
, alcohol in gastric chyme
Elevated gastric pH
Gastric distension
Neural reflexes

Ghrelin

Stomach
Small intestine

Hunger

Histamine

Stomach
mucosa (enterochromaffin cells
Mast cells)
Endocrine cells
in duodenal,
jejunal mucosa

Gastrin
Food in stomach
Acetylcholine (reflexes)
Irritation
Unknown

CNS, PNS
Pancreatic islet
cells
Enteric neurons

Oral nutrient ingestion

Decreased leptin in CNS
Activation of SNS
Neural reflexes

Motilin

Neuropeptide Y
(NPY)
Nitric Oxide

Stomach: stimulates motility (to enhance gastric

emptying) and secretions of acid, pepsinogen
Small intestine: stimulate motility
Ileocecal valve: relaxation
LES: contraction
Large intestine: stimulate mass movement
Gallbladder: mild contraction
Pancreas: mild stimulation of enzyme,HCO3 secretion
Trophic hormone
in Zollinger-Ellison syndrome
Stimulates eating via NPY in lateral hypothalamus
hunger center
Release of growth hormone
Stomach: stimulate acid secretion
Small intestine: stimulate secretions
Regulates interdigestive migrating myoelectric
complex
in fasting state
Strong LES, gastric, small intestinal contraction
during interdigestive phase
Inhibits glucose-stimulated insulin secretion
Stimulates lateral hypothalamus hunger center
Relaxes intestinal smooth muscle, including LE
sphincters
Achalsia: loss of NO secretion may lead to LE tone

Norepinephrine,
Epinephrine

Sympathetic
nerves
Adrenal medulla

Neural reflexes

Opioids/
Enkephalins

Enteric neurons

Neural reflexes

S cells in
duodenal, jejunal
mucosa

Acidic chyme
Partially digested
proteins, fats, hypertonic or
hypotonic fluids
Irritants in chyme (bile
salts)

Enterochromaffin D cells in
gastric and
duodenal mucosa;
cells of
pancreatic islets
Enteric neurons

Food in stomach
Acidic pH in stomach
Neural reflexes

Secretin

Somatostatin

Substance P

Neural reflexes
by Distension, vagal
stimulation
Food in gut

Relaxes GI smooth muscle, except constricts

sphincters
Inhibits secretions
Decreases blood flow
Circular smooth muscle contraction
Intestine: decreases secretion
Inhibits release of VIP, acetylcholine, substance P
Stomach: inhibit motility (delay emptying) and
secretions
Small intestine: inhibit motility
Liver: bile output, especially ductal secretion of
HCO3 to neutralize gastric acid in duodenum
Gallbladder: potentiate CCKs action to contract
Pancreas: stimulate secretion of HCO3; potentiate
CCKs action on enzyme secretion
Inhibits release of neuroendocrine factors
Stomach: inhibits secretion
Intestine: fluid absorption; inhibit secretion
Pancreas: inhibits secretion
Liver: decrease bile flow
Used to treat VIPomas and carcinoid tumors
Relaxes intestinal smooth muscle, including
sphincters
Intestine: stimulates secretion

Vasoactive
Intestinal
Peptide (VIP)

Duodenal
mucosa
Enteric neurons
CNS & PNS

Chyme containing
partially digested foods

Relaxes GI smooth muscle, including sphincters

Intestine: stimulates secretion; smooth muscle
relaxation
Pancreas: secretion; ?regulate release of insulin &
glucagon
VIPoma: non-alpha, non-Beta islet cell pancreatic tumor
that secretes VIP copious diarrhea

Blood supply

Arterial anastomoses which form anastomoses

Internal thoracic (subclavian) < Superior epigastric (internal thoracic) > Inferior epigastric (external iliac)

Venous portal system anastomoses with systemic

Esophageal> Left gastric
Clinical sign: Esophageal varices
Paraumbilical >superficial and inferior epigastric
Clinical sign: Caput Medusae
Superior rectal>middle and inferior rectal
Clinical sign: hemorrhoids (external are painful,due to
somatic innervation)