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Die Schule der Mitte, Gastro- und Neurogastroenterologie, Li Gao: Pi Wei Lun

Neurale Regulation der Magen-Darm-Funktionen

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Freitag, 22.05.2020
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Ist theorieorientiert

The gastrointestinal tract (GIT) is the largest organ in the body. It has a nervous system of its own (the enteric nervous system [ENS]) and has the largest hormone system and the largest immune system of the body.
A. Neural regulation of the GIT is complex and occurs on four integrative levels: 1. The ENS is locally involved in transport, secretion, digestion, absorption and defense. 2. The lower brain stem and the spinal cord are involved in reflex control of the GIT. 3. The upper brain stem and hypothalamus are responsible for the homeostatic regulation of metabolism, food intake, fluid balance and body defense by the GIT. 4. The telencephalon (neocortex, limbic system) is responsible for the adaptation of the internal body processes related to the GIT (homeostatic regulations, interoception) and the behavior of the organism related to the environment.
B. The ENS is represented in the plexus myentericus and plexus submucosus and consists of intrinsic mechanosensitive or chemosensitive primary afferent neurons, interneurons and motoneurons innervating smooth muscles, exocrine cells (mucosa, glands) or endocrine cells as well as possibly the gut associated lymphoid tissues. These enteric neurons form distinct reflex circuits which are integrated with each other in the regulation of the basic functions of the GIT.
C. The brain is informed about the processes in the GIT via vagal afferent neurons (cell bodies in the nodose ganglia) and spinal visceral afferent neurons (cell bodies in the dorsal root ganglia) as well as gastrointestinal hormones and humoral factors (e.g., glucose, lipids) in the blood both acting via the area postrema and other circumventricular organs in the hypothalamus on the neural circuits in the lower brain stem. Vagal and spinal visceral afferent neurons are mechano- and/or chemosensitive and consist functionally of various subtypes. All vagal visceral afferent neurons project to the nucleus tractus solitarii (NTS) in the lower brain stem and spinal visceral afferent neurons project to the spinal dorsal horn.
D. The ENS is controlled by the brain via parasympathetic pathways originating in the nucleus dorsalis nervi vagi (NDNX) or in the intermediate zone of the sacral spinal cord (hindgut) and via sympathetic pathways originating in the intermediate zone of the thoraco-lumbar spinal cord. These autonomic pathways are specialized with respect to the functions of the GIT.
E. Vagal afferent gastrointestinal neurons projecting to the NTS and parasympathetic preganglionic neurons in the NDNX projecting to the GIT form functionally specific vago-vagal reflex pathways. These reflexes are the basic building blocks of the homeostatic regulations of gastrointestinal functions by the upper brain stem, hypothalamus and limbic centers. They are modulated via the area postrema by hormones and humoral factors. NTS, NDNX and area postrema form the dorsal vagal complex. Spinal visceral gastrointestinal afferent neurons and sympathetic preganglionic neurons being involved in gastrointestinal functions form spinal intestino-intestinal reflexes via interneurons. These spinal reflexes are also the basic building blocks of the supraspinal regulation of the GIT involving the sympathetic nervous system.
F. The parasympathetic vago-vagal and sympathetic intestine-intestinal reflex pathways associated with the regulation of the GIT are integral components of the executive homeostatic regulation of the GIT by the hypothalamic and limbic centers. These homeostatic centers together with the dorsal vagal complex and the spinal intestine-intestinal reflex circuits represent the internal state of the organism as far as the GIT tract is concerned. The internal state is adapted to the behavior of the organism by the telencephalon, which monitors and represents the external state of the organism. This idea implies that there is a close integration between the homeostatic regulation of gastrointestinal functions and the higher nervous system functions related to body perception, emotions and behavior. To emphasize, the highly specific autonomic reflex pathways in the spinal cord, brain stem and forebrain are the basis of this integration.

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