Sensory afferents from the gastrointestinal tract

Neural signalling of gut mechanosensation in ingestive and digestive processes

Eating and drinking generate sequential mechanosensory signals along the digestive tract. These signals are communicated to the brain for the timely initiation and regulation of diverse ingestive and digestive processes - ranging from appetite control and tactile perception to gut motility, digestive fluid secretion and defecation - that are vital for the proper intake, breakdown and absorption of nutrients and water. Gut mechanosensation has been investigated for over a century as a common pillar of energy, fluid and gastrointestinal homeostasis, and recent discoveries of specific mechanoreceptors, contributing ion channels and the well-defined circuits underlying gut mechanosensation signalling and function have further expanded our understanding of ingestive and digestive processes at the molecular and cellular levels. In this Review, we discuss our current understanding of the generation of mechanosensory signals from the digestive periphery, the neural afferent pathways that relay these signals to the brain and the neural circuit mechanisms that control ingestive and digestive processes, focusing on the four major digestive tract parts: the oral and pharyngeal cavities, oesophagus, stomach and intestines. We also discuss the clinical implications of gut mechanosensation in ingestive and digestive disorders.

Dissecting the Role of Subtypes of Gastrointestinal Vagal Afferents

Gastrointestinal (GI) vagal afferents convey sensory signals from the GI tract to the brain. Numerous subtypes of GI vagal afferent have been identified but their individual roles in gut function and feeding regulation are unclear. In the past decade, technical approaches to selectively target vagal afferent subtypes and to assess their function has significantly progressed. This review examines the classification of GI vagal afferent subtypes and discusses the current available techniques to study vagal afferents. Investigating the distribution of GI vagal afferent subtypes and understanding how to access and modulate individual populations are essential to dissect their fundamental roles in the gut-brain axis.

Inhibitory effect of luminal saccharides on glucose absorption from an adjacent jejunal site in rats: a newly described intestinal neural reflex

Nutrients in the lumen of the small intestine are sensed by special cells in the epithelial lining. The ensuing neurohumoral reflexes affect gastrointestinal absorption/secretion, motility, and vascular perfusion. To study in vivo the effect of a monosaccharide (glucose) or polysaccharide (starch) present in the jejunum on glucose absorption from an adjacent part of the intestine and investigate the possible underlying mechanisms. Using the single pass intraluminal perfusion technique, a segment of jejunum (perfusion segment) was continuously perfused with 20 mM glucose to determine glucose absorption. One hour later, a bolus of a saccharide was instilled in an isolated adjacent jejunal segment and the change in glucose absorption was monitored for a further 2 h. The contribution of neural mechanisms in this process was investigated. Instillation of glucose (20 mM or 40 mM) in either distal or proximal jejunal pouch elicited immediate and sustained inhibition of glucose absorption (a decrease by 25%; P < 0.01) from the perfused jejunal segment. Comparable inhibition was obtained with instillation of other monosaccharides or starch in the jejunal pouch. This inhibition was abolished by adding tetrodotoxin to the pouch or to the perfused jejunal segment and also by pretreatment with sympathetic blockers (guanethidine or hexamethonium) and by chemical ablation of capsaicin-sensitive primary afferent fibers. Glucose absorption within the jejunum is auto-regulated through backward and forward mechanisms. This regulation is mediated by neural reflexes involving capsaicin-sensitive afferent and sympathetic efferent fibers. These reflexes might serve to protect against hyperglycemia.

Reflex coronary vasoconstriction caused by gallbladder distension in anesthetized pigs

BACKGROUND

Gallbladder distension in anesthetized pigs reflexly increases heart rate and arterial pressure by means of afferent vagal pathways and efferent sympathetic mechanisms. The effect of such distension on the coronary circulation is unknown. The present study was undertaken to determine whether gallbladder distension primarily causes reflex changes in left circumflex blood flow.

METHODS AND RESULTS

In 21 pigs anesthetized with sodium pentobarbitone (16) or alpha-chloralose (5), left circumflex blood flow was measured with an electromagnetic flowmeter. A balloon positioned within the gallbladder was distended with volumes of Ringer's solution equal to the volumes of bile previously withdrawn (mean vol: 62 mL; mean gallbladder pressure: 12 mm Hg). Heart rate and arterial pressure were kept constant by atrial pacing and by a pressurized reservoir connected to the left femoral artery. Gallbladder distension always caused a decrease in circumflex blood flow. In 6 of the 16 sodium pentobarbitone-anesthetized pigs, this decrease was graded by step increments of distension. In 5 of these 16 pigs, the decrease in circumflex blood flow was not affected by atropine. In 10 of these 16 pigs, including those given atropine, the response was not affected by propranolol but was abolished by subsequently giving phentolamine. Cervical vagotomy abolished the coronary vasoconstriction in the remaining 6 pigs. In the 5 alpha-chloralose-anesthetized pigs, the response was not significantly affected by cutting the splanchnic nerves but was abolished by subsequent cervical vagotomy.

CONCLUSIONS

The present study showed that innocuous distension of the gallbladder in anesthetized pigs caused a reflex coronary vasoconstriction that involved efferent sympathetic mechanisms related to alpha-adrenoceptors and afferent vagal pathways.

Integration of postprandial function in the proximal gastrointestinal tract. Role of CCK and sensory pathways

Cholecystokinin (CCK) stimulates vagal afferent fiber discharge, both gastric and intestinal, which seems to result in reflex decrease in gastric motility, gastric acid secretion, and stimulation of pancreatic protein secretion. Endogenous release of CCK by fat or soybean trypsin inhibitor also alters function by way of a capsaicin-sensitive pathway. We suggest that CCK is released locally from the intestine and acts locally or systemically to stimulate vagal afferent fiber discharge to alter proximal gastrointestinal function (Fig. 14). In this way, in addition to its effect on food intake, CCK and the neural pathway integrate function in the proximal gastrointestinal tract, regulating the entry of food into the duodenum to ensure effective digestion and absorption.

Effects of 5-hydroxytryptamine on discharge of vagal mucosal afferent fibres from the upper gastrointestinal tract of the ferret

This study was undertaken to determine the effects of 5-hydroxytryptamine (5-HT) on vagal mucosal afferent endings and how this may relate to their sensitivity to other stimuli. Single afferent fibres with receptive fields in the mucosa of the upper gastrointestinal tract were recorded from the cervical vagus of Urethane anaesthetized ferrets. The selection criteria included failure to respond to luminal distension (i.e., vagal tension receptors were excluded). All fibres tested responded to mucosal stroking. The majority of these (28/32) also responded to close-intrarterially applied 5-HT (10 micrograms) with a brief burst (usually < 15 s) of action potentials, which in 6/6 cases was reduced or abolished by the 5-HT3 receptor antagonist granisetron (0.1-0.5 mg/kg i.v.), as were four responses to cholecystokinin-octapeptide (100-400 pmol close I.A.). The response to 5-HT was shown to be dose-dependent over the dose range 2-75 micrograms on six occasions. Responses to luminal stimuli, which included 150 mM HCl, 1 M NaCl, and mucosal stroking, were not blocked by granisetron although in three fibres, the resting discharge was reduced by the antagonist, suggesting that resting discharge in vagal mucosal afferents may be influenced by endogenously released 5-HT.

Effects of 5-hydroxytryptamine (5-HT) on the discharge of vagal mechanoreceptors and motility in the upper gastrointestinal tract of the ferret

This study was undertaken to investigate the sensitivity of vagal mechanoreceptor afferent fibres from the stomach and small intestine to 5-hydroxytryptamine (5-HT, 10 and 50 micrograms), and to relate this to motor activity. The discharge of single afferent fibres was recorded from the cervical vagus of Urethane anaesthetized ferrets. These had receptive fields in the corpus (15 fibres), antrum (11 fibres), duodenum (3 fibres) or jejunum (1 fibre), and their discharge was excited by distension of the segment containing the receptive field, or by mechanical probing. Conduction velocity was calculated in 7 fibres, and always fell in the C-fibre range (0.84 +/- 0.07 m/s). Injection of 5-HT intra-arterially via the coeliac axis evoked both contraction and relaxation with the dominant effect dependent on region and dose of 5-HT. However, irrespective of the motor response, the mechanoreceptor discharge closely mirrored both the magnitude and the time-course of the motor response. The relationship between the changes in discharge of individual mechanoreceptors and change in intraluminal pressure in all regions in response to both doses of 5-HT fitted a linear regression y = 17.1 +/- 1.2x and was highly significant (P < 0.0001), indicating that 5-HT has no modulatory effect on the sensitivity of mechanoreceptors to changes in intraluminal pressure. This study suggests that vagal mechanoreceptors supplying the gastrointestinal tract respond to changes in motor activity evoked by 5-HT, rather than to 5-HT directly.

Cerebral electrical potentials evoked by balloon distention of the human esophagus

Cerebral evoked potentials provide a technique for evaluation of central nervous processing of information derived from a variety of sensory modalities. Evoked potentials associated with balloon distention of the smooth muscle esophagus were studied in 14 adult volunteers. Stimulation was applied via repeated inflation and deflation of a balloon attached to a pressure pump that cycled at 0.2 Hz. Cortical electrical responses were recorded from scalp electrodes at Cz, Cz', and Pz of the international 10-20 System for electroencephalographic recording. The recording electrodes were referenced to Fpz and averaged over a 1-s period for 100 repetitions. Latencies, amplitudes, and waveforms of the evoked potentials were compared with controls consisting of pump on/balloon detached, auditory masking, and conventional somatosensory posterior tibial nerve stimulation. Polyphasic evoked potentials were obtained in all subjects, and maximum positive deflections occurring with latencies of 202-396 ms. Maximal amplitudes ranged from 2.5-8.3 microV. Latencies and amplitudes of the evoked responses were highly reproducible in each subject with considerable variation among subjects.

CONCLUSIONS

(a) Reproducible evoked potentials with distinctive waveforms can be recorded in response to esophageal balloon distention in humans; (2) long latency of the evoked potentials suggests involvement of nonmyelinated visceral afferent pathways; (3) the evoked potentials are probably specific to mechanical stimulation rather than being nonspecific arousal responses; and (4) the results support this as a promising new method for investigation of the neurobiology of gastrointestinal sensation in humans that may help clarify pathological conditions of the irritable esophagus syndrome and esophagus-related chest pain.

Involvement of gastrointestinal mechano- and intestinal chemoreceptors in vagal reflexes: an electrophysiological study

The role of gastrointestinal mechanoreceptors and intestinal chemoreceptors in the genesis of vago-vagal reflexes was assessed by recording single vagal efferent fibre discharge in the urethane-anaesthetized ferret during procedures known to activate discrete populations of gastrointestinal afferent fibres. Distension of the stomach, duodenum and jejunum was used to activate mechanoreceptors while perfusion of the intestinal loops with various chemical solutions was used to activate mucosal chemoreceptors. Mechanical stimulation of the stomach and/or intestine was effective in modulating vagal efferent discharge in 90% of units tested. The response (either excitation or inhibition of efferent firing) was characterized by its short-latency (less than 1 s), slow-adaptation, and rapid return on removal of the stimulus. In contrast, chemical stimulation was much less potent evoking clear-cut responses in only 26 of the 109 efferent units. Luminal HCl was the most effective stimulus accounting for 81% of the efferent responses although these were of long-latency (greater than 1 min), gradual in onset and poorly maintained. Other efferent responses to HCl and hypertonic saline were characterized by a long-latency, sudden increase in discharge associated with the prodrome of vomiting. We conclude that while the mechanosensitive afferent input is well represented in terms of the genesis of vagal reflexes, the chemosensitive afferent input may be more important in behavioural aspects of visceral stimuli like vomiting.