The nervous system and gastrointestinal function (original) (raw)
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Enteric nervous system, gut-brain connection and related neurodevelopmental disorders (Review paper)
Anatomy, 2020
When compared to other peripheral organs of the body, the gastrointestinal tract (GIT) differs from all of them. GIT has a comprehensive internal nervous system called enteric nervous system (ENS), which can control intestinal function, even if it is totally cut off from the central nervous system (CNS). [1] The ENS provides unique innervation of the intestine and is the most neurochemically diverse part of the peripheral nervous system (PNS). [2] The ENS was described by British physiologist John Newport Langley as one of the three autonomic nervous system parts: parasympathetic nervous system, enteric nervous system and sympathetic nervous system. [3] More than 100 million efferent neurons that reach the intestines through the vagus nerve are present in human ENS. [4] Unlike the rest of the PNS, the complexity of managing bowel behavior is a privilege that evolution provides to the ENS, which has led to the ability to manifest complementary neuronal activity and to control gastrointestinal behavior independently of the brain or spinal cord. [5-7] The ENS has at least as many neurons as in the spinal cord but has more neurons than any other group of peripheral ganglia. Unique to PNS, the ENS is regulated in microcircuits with intrinsic primary afferent neurons (IPANs) and interneurons that are capable of initiating reflexes. The phenotypic diversity of enteric neurons is very wide and almost every class of neurotransmitters found in the CNS has been identified in the ENS. [6] Although the ENS can work independently from the CNS, it normally does not; CNS affects the enteric system and the intestine also sends information to the brain. Indeed, 90% of the vagal fibers between the intestine and the brain are afferent, suggesting that the brain is more recipient than a giver in brainintestinal communication. [6,8] ENS is located within the tubular digestive system walls, biliary system and pancreas. ENS has myenteric and submucosal plexuses, two ganglioned plexuses in the intestine, where almost all intrinsic nerve cells are present. [9] The myenteric plexus is located between the outer longi
Neurogenic Bowel Dysfunction in Children and Adolescents
Journal of Clinical Medicine
Neurogenic/neuropathic bowel dysfunction (NBD) is common in children who are affected by congenital and acquired neurological disease, and negatively impacts quality of life. In the past, NBD received less attention than neurogenic bladder, generally being considered only in spina bifida (the most common cause of pediatric NBD). Many methods of conservative and medical management of NBD are reported, including relatively recently Transanal Irrigation (TAI). Based on the literature and personal experience, an expert group (pediatric urologists/surgeons/gastroenterologists with specific experience in NBD) focused on NBD in children and adolescents. A statement document was created using a modified Delphi method. The range of causes of pediatric NBD are discussed in this paper. The various therapeutic approaches are presented to improve clinical management. The population of children and adolescents with NBD is increasing, due both to the higher survival rate and better diagnosis. Whil...
Enteric Nervous System: Development and Developmental Disturbances--Part 2
Pediatric and Developmental Pathology, 2002
This review, which is presented in two parts, summarizes and synthesizes current views on the genetic, molecular, and cell biological underpinnings of the early embryonic phases of enteric nervous system (ENS) formation and its defects. In the first part, we describe the critical features of two principal abnormalities of ENS development: Hirschsprung's disease (HSCR) and intestinal neuronal dysplasia type B (INDB) in humans, and the similar abnormalities in animals. These represent the extremes of the diagnostic spectrum: HSCR has agreed and unequivocal diagnostic criteria, whereas the diagnosis and even existence of INDB as a clinical entity is highly controversial. The difficulties in diagnosis and treatment of both these conditions are discussed. We then review the genes now known which, when mutated or deleted, may cause defects of ENS development. Many of these genetic abnormalities in animal models give a phenotype similar or identical to HSCR, and were discovered by studies of humans and of mouse mutants with similar defects. The most important of these genes are those coding for molecules in the GDNF intercellular signaling system, and those coding for molecules in the ET-3 signaling system. However, a range of other genes for different signaling systems and for transcription factors also disturb ENS formation when they are deleted or mutated. In addition, a large proportion of HSCR cases have not been ascribed to the currently known genes, suggesting that additional genes for ENS development await discovery.
Journal of Pediatric Gastroenterology and Nutrition, 2004
Research 1. Investigation of enteric neurobiology and development of the enteric nervous system. 2. Neuro-immunology and the gut: characterization of the interactions between the central nervous system, enteric nervous system and immune system. 3. Evaluation of the role of early life events in the development of functional gastrointestinal disorders. Intervention 1. Development of multicenter, controlled studies aimed at evaluating epidemiology, pathophysiology and treatment of functional bowel disorders. 2. Creation of a tissue bank for children with enteric neuromuscular disorders. 3. Validation of the Rome II diagnostic criteria at the general practitioner and specialty level. Education 1. Train physicians and researchers in performing motility, sensory, and laboratory assessment in the field of enteric neuromuscular disorders. 2. Educate primary care physicians in the evaluation and treatment of GER and other functional bowel disorders. 3. Educate care providers on the high incidence of enteric neuromuscular disorders and the special needs of children with neurologic handicaps.
Enteric Nervous System: A Review
2015
Enteric nervous system directs and regulates the breakdown, absorption and elimination of food in our digestive system. However, alongside its digestive functions, enteric nervous system has also gained importance because of the discovery of its bidirectional link with intestinal flora, which has recently started to be considered as a separate organ in addiction to its digestive functions. Enteric nervous system contains approximately 100 million nerve cells, operates both independently and in coordination with the central nervous system, interacts with many neurotransmitters and is related to many conditions and structures such as the intestinal flora, mood, immune system and the efficiency of food utilization. It has a clinical importance on account of the diseases it is associated with. Recent studies focus on the connections between the intestinal flora, enteric nervous system and mechanisms of disease development. In order to understand these studies and pathological mechanisms...
Gastrointestinal Symptoms in a Sample of Children with Pervasive Developmental Disorders
Journal of Autism and Developmental Disorders, 2008
Objective To evaluate gastrointestinal (GI) problems in a large, well-characterized sample of children with pervasive developmental disorders (PDDs). Methods One hundred seventy two children entering one of two trials conducted by the Research Units on Pediatric Psychopharmacology (RUPP) Autism Network were assessed comprehensively prior to starting treatment and classified with regard to GI symptoms. Results Thirty nine (22.7%) were positive for GI problems, primarily constipation and diarrhea. Those with GI problems were no different from subjects without GI problems in demographic characteristics, measures of adaptive functioning, or autism symptom severity. Compared to children without GI problems, those with GI problems showed greater symptom severity on measures of irritability, anxiety, and social withdrawal. Those with GI problems were also less likely to respond to treatment.
Journal of Pediatric Urology, 2016
Objective-Pediatric lower urinary tract dysfunction (LUTD) is a common problem in childhood. Lower urinary tract symptoms in children include overactive bladder, voiding postponement, stress incontinence, giggle incontinence, and dysfunctional voiding. Gastrointestinal co-morbidities, including constipation or fecal incontinence, are commonly associated with lower urinary tract (LUT) symptoms in children, often reaching 22-34%. This review summarized the potential mechanisms underlying functional lower urinary and gastrointestinal co-morbidities in children. It also covered the current understanding of clinical pathophysiology in the pediatric population, anatomy and embryological development of the pelvic organs, role of developing neural circuits in regulation of functional co-morbidities, and relevant translational animal models. Materials and methods-This was a non-systematic review of the published literature, which summarized the available clinical and translational studies on functional urologic and gastrointestinal co-morbidities in children, as well as neural mechanisms underlying pelvic organ 'crosstalk' and 'cross-sensitization'. Results-Co-morbidity of pediatric lower urinary and gastrointestinal dysfunctions could be explained by multiple factors, including a shared developmental origin, close anatomical proximity, and pelvic organ 'cross-talk'. Daily physiological activity and viscero-visceral reflexes between the lower gastrointestinal and urinary tracts are controlled by both autonomic and central nervous systems, suggesting the dominant modulatory role of the neural pathways. Recent studies have provided evidence that altered sensation in the bladder and dysfunctional voiding can be triggered by pathological changes in neighboring pelvic organs due to a phenomenon known as pelvic organ 'cross-sensitization'. Cross-sensitization between pelvic organs is thought to be mainly coordinated by convergent neurons that receive dual afferent inputs from discrete pelvic organs. Investigation of functional changes in nerve fibers and neurons sets certain limits in conducting appropriate research in humans, making the use of animal models necessary to uncover the underlying mechanisms and for the development of novel therapeutic approaches for long-term symptomatic treatment of LUTD in the pediatric population.