Module 3: The gastrointestinal system

The enteric nervous system (ENS) is a complex network of neurons that extends
from the oesophagus to the rectum and is often referred to as the “gut brain”
because of its ability to independently control gut motility and secretion. The ENS
consists of networks of neurons, called plexuses. These networks are within the
GIT, embedded in the muscle and submucosa layers of the gut wall. They act in
short, local feedback loops sensing for example the luminal contents and
responding appropriately, via effectors that control contraction or secretion.
However the GIT is also controlled centrally, and there are long feedback loops
predominantly involving the parasympathetic nervous system.

Learning objectives

By the end of this unit, you should be able to:

Explain the intrinsic and extrinsic nervous system control of the GIT.

Describe how the organisation of the neurons within the enteric nervous system
relate to their function.

The enteric nervous system

Nervous system control

The GI system is regulated by two neural control centres:

Autonomic nervous system (ANS) - extrinsic (outside GIT)

Enteric nervous system (ENS) - intrinsic (within GIT)

The peripheral nervous system can be divided into somatic, autonomic and enteric
nervous systems, determined by the function of the parts of the body they connect
to. The somatic nervous system connects to skeletal muscle, whereas the
autonomic nervous system connects with cardiac and smooth muscle, various
glands, and other tissues - e.g. adipose tissue.

Image source: NS divisions. Kelsie Rotert, UQ.

However there is a further subdivision of the peripheral nervous system called the
enteric nervous system, that's one of the larger systems in our body, the nerve
network of the gastrointestinal tract. It's somewhat autonomous (and therefore not
shown on figure above), and it often referred to as the "gut brain". The ENS consists
of about 100 million neurons, which is similar in number to neurons in the spinal cord
plus the rest of the ANS!

Enteric Nervous System

The two main clusters of neurons that make up the ENS are:

The submucosal (or Meisener's) plexus - found only in the small and large intestine.

The myenteric (or Auerbach's) plexus - found in the circular and longitudinal muscle
layers throughout the GIT.

These neural networks can be easily seen on the cross-sectional schematic below.

Importantly, the submucosal plexus is able to sense the luminal environment,

control mucosal secretion and regulate blood flow. In contrast, the myenteric plexus
coordinates muscular contraction and therefore motility of the GIT. The differences
in distribution of the neurons along the GIT reflect the functions of each segment of
the GIT. Lastly, note there are a few minor plexuses in the mucosa, circular muscle
and underneath the serosa (not shown on the figure below).

Click on the image for a larger view (opens in a new tab)

Image source: Enteric Nervous System by VectorMine Adobe Stock.

Gastrointestinal reflexes

There are reflexes that regulate the GIT. They exhibit similar properties to normal
neural reflexes (as shown in figure below). Usually we characterise the reflex on its
length, with longer reflexes having interneurons in the spinal cord or brain, compared
to short reflexes where the interneurons are found in peripheral ganglia.

Click on the image for a larger view (opens in a new tab)

Image source: 'Short and long reflexes' Access for free at https://openstax.org/books/anatomy-and-
physiology-2e

In the GIT, there are very short or local reflexes where the interneurons are within
the ENS. The short range reflexes, where the interneurons are, are located in the
plexi, whilst long range reflexes, where the interneurons are, are located in the spinal
cord or the brain. Effectors, on the other hand, involve the ANS (parasympathetic
and sympathetic divisions).

Afferent sensory neurons in the ENS generate action potentials in response to

stimuli in the GIT via very short loop (local) reflexes the ENS acts as a "mini-brain"
to regulate itself in a rapid fashion. For example, smooth-muscle tension, pH,
osmolality, levels of specific nutrients, and stretch receptors, is encoded as action
potentials, and relayed to efferent neurons, which innervate cells. The effector cells
are stimulated or inhibited depending on their function. Local ENS reflexes are
important in the control peristalsis, secretion and mixing contractions.

Long range reflexes also involve sensory afferent neurons, but the stimuli from one
site has more widespread affects. Afferent sensory signals are relayed to the CNS
and then via ANS parasympathetic or sympathetic output the CNS regulates the
activity in the GIT, with most innervation targetting the stomach, liver, pancreas and
small intestine. For example, the parasympathetic NS is activated when smelling or
seeing food, which leads to an increase in gastric acid secretion. Whilst in stressful
situations the sympathetic NS is activated, resulting in decrease blood flow to the
GIT and slow digestion, as digestion is not a priority.

Integration of neural responses

The complexity of neural innervation of the GIT is somewhat illustrated in the

diagram below. Whilst there are local, short, and long loop reflexes, there is overall
dual regulation of the GIT as a result of both the intrinsic ENS (local gut brain) and
extrinsic ANS (central nervous system) control. It is thought that the largely
independent function of the ENS has developed as a result of preprogrammed local
responses initiated by sensory signals. Acetylcholine is a key neurotransmitter in the
ENS, although many peptides (eg vasoactive intestinal peptide), amines (serotonin),
and nitric oxide are important neurotransmitters. Extrinsic control of GIT functions is
exerted by the PSNS and to a lesser extent the SNS, often in conjunction with the
ENS.

Image source: 'Neural control of the gut' / Illustration of neural innervation of gut wall by the
Autonomic NS, including sympathetic, parasympathetic and enteric neurons. By Boumphreyfr, CC BY-
SA 3.0, via Wikimedia Commons.