The pharmacological modification of secretory responses

Electrolyte transport across the intestinal mucosa can be modulated by several neurotransmitters, hormones and drugs. Opiate agonists and endogenous opioid peptides inhibit electrolyte secretion both in vitro and in vivo. These drugs appear to act at several levels. Thus, opioid effects can be elicited at the local mucosal level. Secondly, antisecretory effects can be demonstrated when opioids are administered into the brain. These central effects appear to involve activation of the sympathetic innervation of the intestine. Thirdly, some antidiarrhoeal drugs such as loperamide may have ancillary non-opiate-like actions that contribute to their effectiveness. In cases of inflammatory bowel disease where local concentrations of inflammatory mediators such as kinins and eicosanoids may be high, non-steroidal anti-inflammatory drugs may be effective in treating diarrhoeal symptoms. The existence of many types of receptors on mucosal cells indicates that several pharmacological approaches exist for the potential modulation of electrolyte transport.